Provider Demographics
NPI:1043392228
Name:OIL VALLEY PHYSICAL THERAPY INC.
Entity type:Organization
Organization Name:OIL VALLEY PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:814-827-0354
Mailing Address - Street 1:228 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16354-1893
Mailing Address - Country:US
Mailing Address - Phone:814-827-0354
Mailing Address - Fax:814-827-0352
Practice Address - Street 1:228 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16354-1893
Practice Address - Country:US
Practice Address - Phone:814-827-0354
Practice Address - Fax:814-827-0352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007800L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAV0843BOtherUPMC HEALTH PLAN
PA001608909OtherHIGHMARK
PA3149343OtherHEALTHASSURANCE
PA021111Medicare ID - Type Unspecified