Provider Demographics
NPI:1124407796
Name:ORTIZ, JORGE (DPT)
Entity Type:Individual
Prefix:MR
First Name:JORGE
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 MALABAR RD SE
Mailing Address - Street 2:STE 102
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909
Mailing Address - Country:US
Mailing Address - Phone:321-802-9645
Mailing Address - Fax:
Practice Address - Street 1:470 MALABAR RD SE
Practice Address - Street 2:STE 102
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909
Practice Address - Country:US
Practice Address - Phone:321-802-9645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-28
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT-30326225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist