Provider Demographics
NPI:1952411662
Name:MOTTLEY, MAURICE
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:
Last Name:MOTTLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4816 RIVERDALE RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38141-8529
Mailing Address - Country:US
Mailing Address - Phone:901-522-6830
Mailing Address - Fax:901-737-7926
Practice Address - Street 1:4816 RIVERDALE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38141-8529
Practice Address - Country:US
Practice Address - Phone:901-522-6830
Practice Address - Fax:901-737-7926
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5286OtherLICENSE
TN5286OtherLICENSE