Active NPI
Bartley Brett Mortensen, PT
- Physical Therapist
- Provo, UT
National Provider Identifier
1659473361
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 51321992401
- Practice address
- 1055 N 500 W
Suite 122
Provo, UT 84604-3305 - Phone
- (801) 429-0610
- Fax
- (801) 429-0629
- NPI assigned
- Sep 2, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 51321992401 | UT | Primary |
Addresses
Primary practice location
1055 N 500 W
Suite 122
Provo, UT 84604-3305
Mailing address
1055 N 500 W
Credentialing Department
Provo, UT 84604-3305
Phone (801) 429-8000
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 827322 | Other | UT | DMBA |
| 219420 | Other | UT | ALTIUS |
| 64-00662 | Other | UT | UNITED HEALTHCARE |
| 76205 | Other | UT | PEHP |
| P00146137 | Other | UT | PALMETTO |
| 870281028000 | Medicaid | UT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 51321992401 | UT | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Revere Health PC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1263168000000",
"number": "1659473361",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1055 N 500 W",
"address_2": "CREDENTIALING DEPARTMENT",
"city": "PROVO",
"state": "UT",
"postal_code": "846043305",
"telephone_number": "801-429-8000",
"fax_number": "801-429-8150"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1055 N 500 W",
"address_2": "SUITE 122",
"city": "PROVO",
"state": "UT",
"postal_code": "846043305",
"telephone_number": "801-429-0610",
"fax_number": "801-429-0629"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORTENSEN",
"first_name": "BARTLEY",
"middle_name": "BRETT",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-02",
"last_updated": "2010-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "UT",
"license": "51321992401",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DMBA",
"identifier": "827322",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ALTIUS",
"identifier": "219420",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "64-00662",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PEHP",
"identifier": "76205",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PALMETTO",
"identifier": "P00146137",
"state": "UT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "870281028000",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Provo, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.