Provider Demographics
NPI:1710588405
Name:ORTIZ, GISELE (LMT)
Entity Type:Individual
Prefix:MS
First Name:GISELE
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S COURTHOUSE RD APT 4
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-1900
Mailing Address - Country:US
Mailing Address - Phone:434-249-1768
Mailing Address - Fax:
Practice Address - Street 1:500 S COURTHOUSE RD APT 4
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-1900
Practice Address - Country:US
Practice Address - Phone:434-249-1768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-08
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019014502225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist