Provider Demographics
NPI:1376311092
Name:ORTIZ, AMANDA NICOLE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:NICOLE
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 61ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-1615
Mailing Address - Country:US
Mailing Address - Phone:863-233-9001
Mailing Address - Fax:
Practice Address - Street 1:3790 PARK BLVD N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-3611
Practice Address - Country:US
Practice Address - Phone:727-346-8614
Practice Address - Fax:772-732-5151
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL406242251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic