Provider Demographics
NPI:1053825166
Name:ORTIZ, NOEMI MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:NOEMI
Middle Name:MARIE
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:NOEMI
Other - Middle Name:MARIE
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10001 E EVANS AVE APT 75D
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80247-3556
Mailing Address - Country:US
Mailing Address - Phone:303-385-7552
Mailing Address - Fax:
Practice Address - Street 1:3350 PEORIA ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010-1483
Practice Address - Country:US
Practice Address - Phone:303-365-4646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT0012756225700000X
225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist