Provider Demographics
NPI:1376964676
Name:ORTIZ, PIERRE (ATC)
Entity Type:Individual
Prefix:MR
First Name:PIERRE
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:ATC
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 32861
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28232-2861
Mailing Address - Country:US
Mailing Address - Phone:704-280-5004
Mailing Address - Fax:704-512-3825
Practice Address - Street 1:4400 GOLF ACRES DR
Practice Address - Street 2:BLD. J, SUITE D
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-5990
Practice Address - Country:US
Practice Address - Phone:704-280-5004
Practice Address - Fax:704-512-3825
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-04
Last Update Date:2014-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer