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General NPI Number Information
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NPI Number | 1285901025
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Entity Type | Individual
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Provider Name | MICHAEL MOTTOLA PT DPT
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Gender | Male
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Dates
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Enumeration Date | 11/22/2011
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Last Update Date | 04/20/2024
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Provider Practice Location Address
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Address Line | 68 WILLOW RD
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City | MENLO PARK
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State | CA
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Zip | 94025-3653
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Country | US
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Telephone | 866-839-6979
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Fax |
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Provider Business Mailing Address
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Address Line | 220 GREENFIELD AVE
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City | SAN ANSELMO
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State | CA
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Zip | 94960-2416
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Country | US
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Telephone | 415-457-4454
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 033010
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1200661
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 37679
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License Number State | CA
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