Provider Demographics
NPI:1720404437
Name:ASTRERA, MARIA DAISY ORTINERO
Entity Type:Individual
Prefix:
First Name:MARIA DAISY
Middle Name:ORTINERO
Last Name:ASTRERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA DAISY
Other - Middle Name:VILLAFLOR
Other - Last Name:ORTINERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:123 4TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-8619
Mailing Address - Country:US
Mailing Address - Phone:253-848-1234
Mailing Address - Fax:
Practice Address - Street 1:123 4TH AVE NW
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-8619
Practice Address - Country:US
Practice Address - Phone:253-848-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-05
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013595225100000X
MD24428225100000X
WAPT 60181848225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist