Provider Demographics
NPI:1790999589
Name:ORTIZ, LUIS TONY (ATC)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:TONY
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2398 GREENLAWN DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434-7026
Mailing Address - Country:US
Mailing Address - Phone:937-429-2643
Mailing Address - Fax:937-775-4252
Practice Address - Street 1:3640 COLONEL GLEN HWY
Practice Address - Street 2:ROOM 303 NUTTER CENTER
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45435
Practice Address - Country:US
Practice Address - Phone:937-775-3827
Practice Address - Fax:937-775-4252
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0003192255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer