Provider Demographics
NPI:1619209335
Name:ORTA, VICTOR ROBERT (PT)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:ROBERT
Last Name:ORTA
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 1:2999 NW PLOTSKY AVE
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64477-9511
Mailing Address - Country:US
Mailing Address - Phone:816-539-3350
Mailing Address - Fax:
Practice Address - Street 1:2999 NW PLOTSKY AVE
Practice Address - Street 2:
Practice Address - City:PLATTSBURG
Practice Address - State:MO
Practice Address - Zip Code:64477-9511
Practice Address - Country:US
Practice Address - Phone:816-539-3350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006005288225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist