Provider Demographics
NPI:1679269237
Name:ORTIZ, RUBEN O (LMT)
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:O
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 SARGEANT ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21223-3630
Mailing Address - Country:US
Mailing Address - Phone:443-414-0756
Mailing Address - Fax:
Practice Address - Street 1:1250 SARGEANT ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-3630
Practice Address - Country:US
Practice Address - Phone:443-414-0756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM05205225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist