Provider Demographics
NPI:1770013989
Name:ORTIZ GONZALEZ, MARIGLORIA (PT)
Entity Type:Individual
Prefix:
First Name:MARIGLORIA
Middle Name:
Last Name:ORTIZ GONZALEZ
Suffix:
Gender:F
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:PO BOX 370713
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737-0713
Mailing Address - Country:US
Mailing Address - Phone:787-595-1826
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 191227
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00919-1227
Practice Address - Country:US
Practice Address - Phone:778-758-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1272225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist