Provider Demographics
NPI:1376772434
Name:MUNIZ, CORTNIE M (DPT)
Entity Type:Individual
Prefix:
First Name:CORTNIE
Middle Name:M
Last Name:MUNIZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CORTNIE
Other - Middle Name:M
Other - Last Name:ULRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:805 AEROVISTA PL
Mailing Address - Street 2:201
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7919
Mailing Address - Country:US
Mailing Address - Phone:805-788-0805
Mailing Address - Fax:805-544-6468
Practice Address - Street 1:350 POSADA LN
Practice Address - Street 2:103
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-4059
Practice Address - Country:US
Practice Address - Phone:805-434-2050
Practice Address - Fax:805-434-0065
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35813225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA9102Medicare PIN