Provider Demographics
NPI:1336617299
Name:ORTUVIA, OMMAR (PT)
Entity Type:Individual
Prefix:
First Name:OMMAR
Middle Name:
Last Name:ORTUVIA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16427 JADESTONE TERRACE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77044-1167
Mailing Address - Country:US
Mailing Address - Phone:832-328-8972
Mailing Address - Fax:
Practice Address - Street 1:19298 W LAKE HOUSTON PKWY STE 240
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-4827
Practice Address - Country:US
Practice Address - Phone:832-828-4990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1186243225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist