Healthcare Provider Details

I. General information

NPI: 1558774935
Provider Name (Legal Business Name): TOBY ALLEN BORTNER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2014
Last Update Date: 06/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 HOUNDS RUN
GETTYSBURG PA
17325-7890
US

IV. Provider business mailing address

39 HOUNDS RUN
GETTYSBURG PA
17325-7890
US

V. Phone/Fax

Practice location:
  • Phone: 717-398-9900
  • Fax:
Mailing address:
  • Phone: 717-398-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License Number21375
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License NumberPT008376L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: