MEDICARE: MR. MARK A MOTTILLO PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT007800L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	V0843B	OTHER	PA	UPMC
2	85873	OTHER	PA	HIGHMARK
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	5622458	OTHER	PA	FIRST HEALTH

General Provider Information

NPI Number	:	1598766024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK A MOTTILLO PT

Provider Business Mailing Address
First Line	:	125 W WALNUT ST
Second Line	:
City	:	TITUSVILLE
State	:	PA
Zip	:	16354-2517
Country	:	US
Telephone Number	:	814-827-0354
Fax Number	:	814-827-0352

Provider Business Practice Location Address
First Line	:	4247 W RIDGE RD STE 104
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16506-1746
Country	:	US
Telephone Number	:	814-833-7249
Fax Number	:	814-838-2661

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	09/15/2023

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