Provider Demographics
NPI:1730225285
Name:VORTMAN, MATTHEW DALE (PT)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:DALE
Last Name:VORTMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 BOYSENBERRY LN
Mailing Address - Street 2:APARTMENT #4
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-8276
Mailing Address - Country:US
Mailing Address - Phone:217-491-2384
Mailing Address - Fax:
Practice Address - Street 1:3132 OLD JACKSONVILLE RD STE 140
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-7401
Practice Address - Country:US
Practice Address - Phone:217-862-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist