Provider Demographics
NPI:1689744203
Name:ORTMANN, MARK RALPH (MS, PT, OCS)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:RALPH
Last Name:ORTMANN
Suffix:
Gender:M
Credentials:MS, PT, OCS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11951 US HIGHWAY 1 STE 105
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-2804
Mailing Address - Country:US
Mailing Address - Phone:561-630-8722
Mailing Address - Fax:561-630-8729
Practice Address - Street 1:11951 US HIGHWAY 1 STE 105
Practice Address - Street 2:
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-2804
Practice Address - Country:US
Practice Address - Phone:561-630-8722
Practice Address - Fax:561-630-8729
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL15947225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889091900Medicaid
FL15947OtherPT NUMBER
FL201080094OtherTAX ID NUMBER
FL889091900Medicaid