Provider Demographics
NPI:1922498831
Name:HORTILLO, MARY JANE (DPT)
Entity Type:Individual
Prefix:
First Name:MARY JANE
Middle Name:
Last Name:HORTILLO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 GOLDENRAIN DR
Mailing Address - Street 2:APT 3104
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5089
Mailing Address - Country:US
Mailing Address - Phone:407-461-3188
Mailing Address - Fax:
Practice Address - Street 1:233 GOLDENRAIN DR
Practice Address - Street 2:APT 3104
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34747-5089
Practice Address - Country:US
Practice Address - Phone:407-461-3188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 12484225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist