Provider Demographics
NPI:1225843212
Name:MORTILLARO, ISABEL
Entity type:Individual
Prefix:
First Name:ISABEL
Middle Name:
Last Name:MORTILLARO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 WERTLAND ST APT 11
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-2883
Mailing Address - Country:US
Mailing Address - Phone:860-944-6307
Mailing Address - Fax:
Practice Address - Street 1:1204 WERTLAND ST APT 11
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-2883
Practice Address - Country:US
Practice Address - Phone:860-944-6307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-08
Last Update Date:2025-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer