Provider Demographics
NPI:1720316730
Name:ORTEGA FLORES, PAULA MARIA (LMT)
Entity Type:Individual
Prefix:MISS
First Name:PAULA
Middle Name:MARIA
Last Name:ORTEGA FLORES
Suffix:
Gender:F
Credentials:LMT
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Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2121 SOUTH KINNICKINNIC AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207
Mailing Address - Country:US
Mailing Address - Phone:414-744-0707
Mailing Address - Fax:414-744-0708
Practice Address - Street 1:2121 SOUTH KINNICKINNIC AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207
Practice Address - Country:US
Practice Address - Phone:414-744-0707
Practice Address - Fax:414-744-0708
Is Sole Proprietor?:No
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI4695-046225700000X
571550-09225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist