Provider Demographics
NPI:1972265023
Name:ORTIZ MARTINEZ, RANDY RAFAEL (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:RAFAEL
Last Name:ORTIZ MARTINEZ
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2749 WOODSTREAM CIR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-5348
Mailing Address - Country:US
Mailing Address - Phone:407-414-6913
Mailing Address - Fax:
Practice Address - Street 1:395 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-4012
Practice Address - Country:US
Practice Address - Phone:407-914-9168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-06
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT37601225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty