Provider Demographics
NPI:1306038518
Name:ORTIZ, VINCENT (PTA)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1172 S DIXIE HWY
Mailing Address - Street 2:#548
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2918
Mailing Address - Country:US
Mailing Address - Phone:305-445-8066
Mailing Address - Fax:305-913-3141
Practice Address - Street 1:1200 ANASTASIA AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-6339
Practice Address - Country:US
Practice Address - Phone:305-445-8066
Practice Address - Fax:305-913-3141
Is Sole Proprietor?:No
Enumeration Date:2007-08-11
Last Update Date:2007-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA15919225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant