Provider Demographics
NPI:1801145677
Name:ORTEGO, WOODY LEE
Entity type:Individual
Prefix:
First Name:WOODY
Middle Name:LEE
Last Name:ORTEGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3524 KALISTE SALOOM RD BLDG 2
Mailing Address - Street 2:STE. 205
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7638
Mailing Address - Country:US
Mailing Address - Phone:337-993-2766
Mailing Address - Fax:337-993-2764
Practice Address - Street 1:3524 KALISTE SALOOM RD BLDG 2
Practice Address - Street 2:STE. 205
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7638
Practice Address - Country:US
Practice Address - Phone:337-993-2766
Practice Address - Fax:337-993-2764
Is Sole Proprietor?:No
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08437R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist