Provider Demographics
NPI:1699034272
Name:MARCANO ORTIZ, DHALMA YANISSE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:DHALMA
Middle Name:YANISSE
Last Name:MARCANO ORTIZ
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 1:12612 CHALLENGER PKWY STE 365
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-2784
Mailing Address - Country:US
Mailing Address - Phone:407-306-8441
Mailing Address - Fax:
Practice Address - Street 1:12612 CHALLENGER PKWY STE 365
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-2784
Practice Address - Country:US
Practice Address - Phone:407-306-8441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1434225100000X
NY040519225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist