Provider Demographics
NPI:1578596037
Name:CORTINA, VICTOR M (PT)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:M
Last Name:CORTINA
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:PO BOX 25306
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29616-0306
Mailing Address - Country:US
Mailing Address - Phone:864-621-5646
Mailing Address - Fax:678-840-2112
Practice Address - Street 1:800 PELHAM RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3300
Practice Address - Country:US
Practice Address - Phone:864-621-5646
Practice Address - Fax:678-840-2112
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3658225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist