| Doctor Name: | MRS. KRISTIN LORRIE MORTENSON |
| NPI Number: | 1053785204 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DPT |
| License Number: | PT30641 |
| Business Practice Address: | 1402 Se 16th Pl Cape Coral, FL - 339903819 |
| Business Phone Number: | 2397722363 |
| Business Fax Number: | |
| Mailing Address: | 1402 Se 16th Pl, CAPE CORAL |
| State: | FL |
| Postal Code: | 339903819 |
| Phone Number: | 2397722363 |
| Fax Number: | |
| NPI Enumeration Date: | 11/25/2015 |
| NPI Last Update Date: | 11/25/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251S0007X |
| License Number: | PT30641 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Sports |
| Taxonomy Definition: | |