Provider Demographics
NPI:1134138001
Name:ORTIZ FUENTES, ISAMARIS (DPT)
Entity Type:Individual
Prefix:
First Name:ISAMARIS
Middle Name:
Last Name:ORTIZ FUENTES
Suffix:
Gender:F
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:PO BOX 2884
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-2800
Mailing Address - Country:US
Mailing Address - Phone:787-887-2555
Mailing Address - Fax:787-657-5600
Practice Address - Street 1:CALLE GARCIA DE LA NOCEDA B18
Practice Address - Street 2:VILLAS DE RIO GRANDE
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745-0000
Practice Address - Country:US
Practice Address - Phone:787-887-2555
Practice Address - Fax:787-657-5600
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1307225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0085426AMedicare PIN
PRQ61245Medicare UPIN