Provider Demographics
NPI:1427186972
Name:GARCIA-ORTIZ, RAFAEL (PTA)
Entity Type:Individual
Prefix:MR
First Name:RAFAEL
Middle Name:
Last Name:GARCIA-ORTIZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 SW 75TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4415
Mailing Address - Country:US
Mailing Address - Phone:786-208-0955
Mailing Address - Fax:305-262-1971
Practice Address - Street 1:1890 SW 57TH AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-2164
Practice Address - Country:US
Practice Address - Phone:786-208-0955
Practice Address - Fax:305-262-1971
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 20376225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant