Active NPI
Heather Mortenson
- Physical Therapist
- Verona, WI
National Provider Identifier
1881858223
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 10295-24
- Practice address
- 1049 N Edge TRL
Verona, WI 53593-1942 - Phone
- (608) 845-2100
- Fax
- (608) 845-2101
- NPI assigned
- Jul 15, 2008
- Last updated
- Jun 29, 2011
- Sex
- Female
- Sole proprietor
- Yes
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 | 10295-24 | WI | Primary |
Addresses
Primary practice location
1049 N Edge TRL
Verona, WI 53593-1942
Mailing address
1049 N Edge TRL
Verona, WI 53593-1942
Phone (608) 845-2100
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000083455 | Other | WI | MEDICARE |
| 36146500 | Medicaid | WI |
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 |
|---|---|---|---|
| 10295-24 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1216080000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1309305600000",
"number": "1881858223",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1049 N EDGE TRL",
"city": "VERONA",
"state": "WI",
"postal_code": "535931942",
"telephone_number": "608-845-2100",
"fax_number": "608-845-2101"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1049 N EDGE TRL",
"city": "VERONA",
"state": "WI",
"postal_code": "535931942",
"telephone_number": "608-845-2100",
"fax_number": "608-845-2101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORTENSON",
"first_name": "HEATHER",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-07-15",
"last_updated": "2011-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "10295-24",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "000083455",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "36146500",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Verona, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.