Provider Demographics
NPI:1689889438
Name:OVITZ, OTTO BRUCE (PT)
Entity Type:Individual
Prefix:MR
First Name:OTTO
Middle Name:BRUCE
Last Name:OVITZ
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 1:465-150 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96114-8649
Mailing Address - Country:US
Mailing Address - Phone:530-253-2150
Mailing Address - Fax:
Practice Address - Street 1:465-150 CHURCH ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:CA
Practice Address - Zip Code:96114-8649
Practice Address - Country:US
Practice Address - Phone:530-253-2150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT5623225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist