Provider Demographics
NPI:1306887278
Name:MORTLAND PHYSICAL THERAPY & SPORTS MEDICINE
Entity type:Organization
Organization Name:MORTLAND PHYSICAL THERAPY & SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:MORTLAND
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:724-942-8990
Mailing Address - Street 1:451 VALLEY BROOK RD
Mailing Address - Street 2:
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-3353
Mailing Address - Country:US
Mailing Address - Phone:724-942-8990
Mailing Address - Fax:724-942-4461
Practice Address - Street 1:451 VALLEY BROOK RD
Practice Address - Street 2:
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-3353
Practice Address - Country:US
Practice Address - Phone:724-942-8990
Practice Address - Fax:724-942-4461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006410L2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
077149Medicare ID - Type Unspecified