Provider Demographics
NPI:1306155254
Name:MORDUS, JOSEPH BENJAMIN (PT, DPT,MPH, MBA)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:BENJAMIN
Last Name:MORDUS
Suffix:
Gender:M
Credentials:PT, DPT,MPH, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ECHO RD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:CT
Mailing Address - Zip Code:06784-2508
Mailing Address - Country:US
Mailing Address - Phone:860-237-5511
Mailing Address - Fax:860-207-8005
Practice Address - Street 1:4 ECHO RD
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:CT
Practice Address - Zip Code:06784-2508
Practice Address - Country:US
Practice Address - Phone:860-237-5511
Practice Address - Fax:860-207-8005
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033098-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist