Provider Demographics
NPI:1164694865
Name:ORTOLANO, MEGAN C (PT)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:C
Last Name:ORTOLANO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 DUNHAM HOLLOW ROAD
Mailing Address - Street 2:
Mailing Address - City:EAST NASSAU
Mailing Address - State:NY
Mailing Address - Zip Code:12062
Mailing Address - Country:US
Mailing Address - Phone:518-526-9301
Mailing Address - Fax:518-766-5658
Practice Address - Street 1:84 DUNHAM HOLLOW ROAD
Practice Address - Street 2:
Practice Address - City:EAST NASSAU
Practice Address - State:NY
Practice Address - Zip Code:12062
Practice Address - Country:US
Practice Address - Phone:518-526-9301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0048291225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist