Provider Demographics
NPI:1558584219
Name:ORTIGARA, JOSEPH (PT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:ORTIGARA
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 1:6912 173RD PL
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-3430
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16651 HARLEM AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-2581
Practice Address - Country:US
Practice Address - Phone:708-444-2467
Practice Address - Fax:708-444-2758
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL70003821225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00943131OtherMEDICARE RAILROAD
IL216859010Medicare PIN
IL216859179Medicare PIN
ILP00943131OtherMEDICARE RAILROAD
ILP00651154Medicare PIN
ILR02864Medicare PIN