Provider Demographics
NPI:1538683966
Name:MORTIMER, CASONDRA L (DPT)
Entity Type:Individual
Prefix:
First Name:CASONDRA
Middle Name:L
Last Name:MORTIMER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CASONDRA
Other - Middle Name:L
Other - Last Name:WELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:313 NEFF AVE STE C
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3495
Mailing Address - Country:US
Mailing Address - Phone:540-434-1200
Mailing Address - Fax:540-434-1203
Practice Address - Street 1:313 NEFF AVE STE C
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3495
Practice Address - Country:US
Practice Address - Phone:540-434-1200
Practice Address - Fax:540-434-1203
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305211345225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist