Provider Demographics
NPI:1508018367
Name:ORTIZ, BEVERLY ANNE (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY ANNE
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:705 W PLAINFIELD RD
Practice Address - Street 2:SUITE 1
Practice Address - City:COUNTRYSIDE
Practice Address - State:IL
Practice Address - Zip Code:60525-3684
Practice Address - Country:US
Practice Address - Phone:708-352-1362
Practice Address - Fax:708-352-1365
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.015128225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist