Provider Demographics
NPI:1124003900
Name:ORTMAYER, ROBERT DEAN (PT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DEAN
Last Name:ORTMAYER
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 1:16615 YORBA LINDA BLVD
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-2046
Mailing Address - Country:US
Mailing Address - Phone:714-577-0745
Mailing Address - Fax:714-577-8653
Practice Address - Street 1:16615 YORBA LINDA BLVD
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-2046
Practice Address - Country:US
Practice Address - Phone:714-577-0745
Practice Address - Fax:714-577-8653
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT21322225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGN201ZMedicare PIN