Provider Demographics
NPI:1902182934
Name:REYES-ORTIZ, JOSE M (LMT, CNMT)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:M
Last Name:REYES-ORTIZ
Suffix:
Gender:M
Credentials:LMT, CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6467 SKYWAE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-2065
Mailing Address - Country:US
Mailing Address - Phone:740-804-1477
Mailing Address - Fax:
Practice Address - Street 1:1110 BEECHER XING N STE B
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-4564
Practice Address - Country:US
Practice Address - Phone:614-855-8828
Practice Address - Fax:614-530-0588
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH018993225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist