Provider Demographics
NPI:1487799532
Name:ORTIZ, SONIA R (PT)
Entity type:Individual
Prefix:MRS
First Name:SONIA
Middle Name:R
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16328 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3339
Mailing Address - Country:US
Mailing Address - Phone:917-826-7715
Mailing Address - Fax:718-352-9440
Practice Address - Street 1:16328 19TH AVE
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-3339
Practice Address - Country:US
Practice Address - Phone:917-826-7715
Practice Address - Fax:718-352-9440
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007955225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist