Provider Demographics
NPI:1962162313
Name:MORTENSEN, CADE (PT, DPT)
Entity type:Individual
Prefix:
First Name:CADE
Middle Name:
Last Name:MORTENSEN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5656 S POWER RD STE 139
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-8490
Mailing Address - Country:US
Mailing Address - Phone:480-272-7797
Mailing Address - Fax:
Practice Address - Street 1:5656 S POWER RD STE 139
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-8490
Practice Address - Country:US
Practice Address - Phone:480-272-7797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-32130225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist