Provider Demographics
NPI:1275727505
Name:DORSA, PETER G (MSPT)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:G
Last Name:DORSA
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 READING ROAD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241
Mailing Address - Country:US
Mailing Address - Phone:513-733-3370
Mailing Address - Fax:513-786-7893
Practice Address - Street 1:10400 READING ROAD
Practice Address - Street 2:SUITE 105
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241
Practice Address - Country:US
Practice Address - Phone:513-733-3370
Practice Address - Fax:513-786-7893
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.01481225100000X
CO4743225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C547178Medicare PIN