MEDICARE: MAURICE MOTTLEY

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5286	OTHER	TN	LICENSE

General Provider Information

NPI Number	:	1952411662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAURICE MOTTLEY

Provider Business Mailing Address
First Line	:	4816 RIVERDALE RD
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38141-8529
Country	:	US
Telephone Number	:	901-522-6830
Fax Number	:	901-737-7926

Provider Business Practice Location Address
First Line	:	4816 RIVERDALE RD
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38141-8529
Country	:	US
Telephone Number	:	901-522-6830
Fax Number	:	901-737-7926

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	12/09/2010

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Directions to “ MAURICE MOTTLEY ” Practice Location

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