Provider Demographics
NPI:1669839528
Name:ORTEGA ORTEGA, LIZBETH M (MSPT)
Entity Type:Individual
Prefix:
First Name:LIZBETH
Middle Name:M
Last Name:ORTEGA ORTEGA
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 2 BOX 7077
Mailing Address - Street 2:
Mailing Address - City:CIALES
Mailing Address - State:PR
Mailing Address - Zip Code:00638-9507
Mailing Address - Country:US
Mailing Address - Phone:787-346-0380
Mailing Address - Fax:
Practice Address - Street 1:260 CALLE 54 SE
Practice Address - Street 2:URB LA RIVIERA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00929
Practice Address - Country:US
Practice Address - Phone:787-999-5538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-24
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4535261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy