Organization
MOUNT NITTANY MEDICAL CENTER
Active
Organization
MOUNT NITTANY MEDICAL CENTER
Active
Other names
Mount Nittany Medical Center Orthotics Supplier
Organization subpart
No
Provider details
NPI number
Authorized official
BRYAN ROACH (CFO)
(814) 234-6148
Entity
Organization
Contact information
Practice address
120 RADNOR RD STE 100, MNMC - ORTHOTICS, STATE COLLEGE, PA 16801-7970
(814) 231-7125
(814) 238-4167
Mailing address
155 WELLNESS WAY, STATE COLLEGE, PA 16803-6702
(814) 231-7868
(814) 231-7098
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100746655 0020
—
PA
Enumeration date
07/19/2007
Last updated
05/14/2026
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