Provider Demographics
NPI:1043987480
Name:EBERTS-TORTORA, MIA
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:EBERTS-TORTORA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 BATTALION PL
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:OH
Mailing Address - Zip Code:43119-8529
Mailing Address - Country:US
Mailing Address - Phone:614-735-0113
Mailing Address - Fax:
Practice Address - Street 1:380 ELM ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-9220
Practice Address - Country:US
Practice Address - Phone:740-852-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist