Jordan L Mortensen, DPT
Individual provider Active NPI Physical Therapist · Wyocena, WI
NPI 1447770664 · NPPES record last updated Mar 17, 2018
Key facts
- NPI
- 1447770664
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 13697-24 (WI)
- Practice address
- 323 W Monroe Street
Wyocena, WI 53969 - Phone
- (608) 429-2181
- NPI assigned
- Jun 20, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Capitol Physical Therapy Specialists LLC
Practice addresses (Care Compare)
416 E Verona Ave
Verona, WI 53593-1227
Phone (608) 848-6628
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171009003527 | WI | Practitioner - Physical Therapist in Private Practice | 4486929940 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13697-24 | WI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Associated Physicians, LLP | Physical Therapist | Current |
Accepting new patients |
| Capitol Physical Therapy Specialists LLC | Physical Therapist | Current |
Accepting new patients |
Locations
3525 University Ave
Madison, WI 53705
Phone (608) 467-3537
4410 Regent St
Madison, WI 53705
Phone (608) 233-9746
1215 Springdale St
Mount Horeb, WI 53572
Phone (608) 437-0222
416 E Verona Ave
Verona, WI 53593
Phone (608) 848-6628
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 13697-24 | WI | Yes |
Addresses
Primary practice location
323 W Monroe Street
Wyocena, WI 53969
Mailing address
1924 Atwood Ave
#107
Madison, WI 53704
Phone (715) 571-8482
Other practice location 1
323 W Monroe St
Wyocena, WI 53969
Phone (608) 429-2181
Other practice location 2
1924 Atwood Ave
#107
Madison, WI 53704-5370
Phone (715) 571-8482
Other providers in Wyocena, WI
- Mandi Ann Herwig
- Jennifer Lynne Hornbaker
- Jamie N. Kuhls
- Dallas Roger Loukes
- Teagan Marcouiller
- Alison Nygaard
- Stacy Padley
- Carley A Priske
- Ean Van Vliet
All providers in Wyocena, WI · Physical Therapist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.