Provider Demographics
NPI:1013280395
Name:ORTIZ, MELISSA (LMT, PTA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:LMT, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 BUCKHORN PRESERVE BLVD
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596
Mailing Address - Country:US
Mailing Address - Phone:813-412-0278
Mailing Address - Fax:
Practice Address - Street 1:2605 BUCKHORN PRESERVE BLVD
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596
Practice Address - Country:US
Practice Address - Phone:813-412-0278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-16
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 53136175L00000X
FL53136225700000X
FL25408225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No175L00000XOther Service ProvidersHomeopath
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist