Provider Demographics
NPI:1407863160
Name:CORTEZ, DENNIS DOMINGUEZ (PT)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:DOMINGUEZ
Last Name:CORTEZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9131 219TH ST
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11428-1342
Mailing Address - Country:US
Mailing Address - Phone:646-515-4444
Mailing Address - Fax:718-776-1169
Practice Address - Street 1:4359 147TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-1739
Practice Address - Country:US
Practice Address - Phone:718-445-3729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022147225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist