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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