Provider Demographics
NPI:1417151531
Name:ORTIZ, JONATHAN A (PT)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:A
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 LONGMEADOW DR
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1545
Mailing Address - Country:US
Mailing Address - Phone:847-730-3540
Mailing Address - Fax:
Practice Address - Street 1:700 E EUCLID AVE
Practice Address - Street 2:
Practice Address - City:PROSPECT HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60070-3409
Practice Address - Country:US
Practice Address - Phone:847-797-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070011810225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist