Provider Demographics
NPI:1912209974
Name:ORTIZ, DARRELL RHEA (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:DARRELL
Middle Name:RHEA
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7618 CALYPSO DR
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-5431
Mailing Address - Country:US
Mailing Address - Phone:972-475-1955
Mailing Address - Fax:
Practice Address - Street 1:7618 CALYPSO DR
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-5431
Practice Address - Country:US
Practice Address - Phone:972-475-1955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT0464171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor