Provider Demographics
NPI:1003902362
Name:ORTIZ, LORI ANN (MPT)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:ANN
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:LEON
Other - Last Name:HOWEYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:ACL INDIAN HOSP IHS ATTN BUS OFFICE
Mailing Address - City:SAN FIDEL
Mailing Address - State:NM
Mailing Address - Zip Code:87049
Mailing Address - Country:US
Mailing Address - Phone:505-552-5385
Mailing Address - Fax:505-552-5473
Practice Address - Street 1:6 BASSWOOD RD
Practice Address - Street 2:
Practice Address - City:PARAJE
Practice Address - State:NM
Practice Address - Zip Code:87007
Practice Address - Country:US
Practice Address - Phone:505-431-0704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM40403262Medicaid
320070Medicare ID - Type Unspecified
PHS000Medicare UPIN