Active NPI
Mark Douglas Mottice, PT
- Physical Therapist
- Canton, OH
National Provider Identifier
1679594824
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT 003209
- Practice address
- 4645 Belpar St NW
Canton, OH 44718-3602 - Phone
- (330) 493-4210
- Fax
- (330) 493-4744
- NPI assigned
- Jul 22, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT 003209 | OH | Primary |
Addresses
Primary practice location
4645 Belpar St NW
Canton, OH 44718-3602
Mailing address
4645 Belpar St NW
Canton, OH 44718-3602
Phone (330) 493-4210
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000134718 | Other | OH | ANTHEM BC/BS |
| 299522343001 | Other | OH | MEDICAL MUTUAL OF OHIO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT 003209 | OH | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Novacare Rehabilitation of Ohio Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapy Clinic/Center
- Beechwood, OH
- NPI 1740447895
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153526400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1679594824",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4645 BELPAR ST NW",
"city": "CANTON",
"state": "OH",
"postal_code": "447183602",
"telephone_number": "330-493-4210",
"fax_number": "330-493-4744"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4645 BELPAR ST NW",
"city": "CANTON",
"state": "OH",
"postal_code": "447183602",
"telephone_number": "330-493-4210",
"fax_number": "330-493-4744"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOTTICE",
"first_name": "MARK",
"middle_name": "DOUGLAS",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OH",
"license": "PT 003209",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BC/BS",
"identifier": "000000134718",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL MUTUAL OF OHIO",
"identifier": "299522343001",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Canton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.