Provider Demographics
NPI:1285486266
Name:ORTEGA TANUS, JOSE GUILLERMO (LMT)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:GUILLERMO
Last Name:ORTEGA TANUS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W WINONA ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-3925
Mailing Address - Country:US
Mailing Address - Phone:215-273-6823
Mailing Address - Fax:
Practice Address - Street 1:300 W WINONA ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-3925
Practice Address - Country:US
Practice Address - Phone:215-273-6823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG012823225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist