Provider Demographics
NPI:1407042302
Name:ORTIZ, CHRISTOPHER JOHN PAYUMO (PT)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER JOHN
Middle Name:PAYUMO
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:CHRISTOPHER JOHN
Other - Middle Name:PAYUMO
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:3201 W COMMERCIAL BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3440
Mailing Address - Country:US
Mailing Address - Phone:410-979-4911
Mailing Address - Fax:
Practice Address - Street 1:3201 W COMMERCIAL BLVD STE B
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-3440
Practice Address - Country:US
Practice Address - Phone:410-979-4911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62029313225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist