Provider Demographics
NPI:1417373630
Name:CORTEZ, LUISA BALINGIT (PT)
Entity Type:Individual
Prefix:
First Name:LUISA
Middle Name:BALINGIT
Last Name:CORTEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S 29TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-3626
Mailing Address - Country:US
Mailing Address - Phone:772-252-4618
Mailing Address - Fax:
Practice Address - Street 1:700 S 29TH ST
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-3626
Practice Address - Country:US
Practice Address - Phone:772-252-4618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070019766225100000X
FLPT29100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist