Provider Demographics
NPI:1245378504
Name:MORTENSEN, JILINDA KAY (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JILINDA
Middle Name:KAY
Last Name:MORTENSEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 LOGAN ST
Mailing Address - Street 2:
Mailing Address - City:SCRIBNER
Mailing Address - State:NE
Mailing Address - Zip Code:68057-3114
Mailing Address - Country:US
Mailing Address - Phone:402-372-7964
Mailing Address - Fax:
Practice Address - Street 1:430 N MONITOR ST
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:NE
Practice Address - Zip Code:68788-1555
Practice Address - Country:US
Practice Address - Phone:402-372-2372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE511225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant