Provider Demographics
NPI:1952542946
Name:ORTEGA, DESIREE (LMT)
Entity Type:Individual
Prefix:MS
First Name:DESIREE
Middle Name:
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5435 NW 10TH CT
Mailing Address - Street 2:#303
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33313-6478
Mailing Address - Country:US
Mailing Address - Phone:954-797-7077
Mailing Address - Fax:954-797-7077
Practice Address - Street 1:570 OCEAN DR
Practice Address - Street 2:501
Practice Address - City:JUNO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-1952
Practice Address - Country:US
Practice Address - Phone:954-491-2225
Practice Address - Fax:954-491-6862
Is Sole Proprietor?:No
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA42651OtherLICENSED MASSAGE THERAPYST