Provider Demographics
NPI:1528786571
Name:ORTIZ GONZALEZ, YULIANNA (PTA)
Entity type:Individual
Prefix:
First Name:YULIANNA
Middle Name:
Last Name:ORTIZ GONZALEZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 NORTHLAKE BLVD APT 2028
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-5272
Mailing Address - Country:US
Mailing Address - Phone:386-956-4936
Mailing Address - Fax:
Practice Address - Street 1:10395 NARCOOSSEE RD STE E
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-6939
Practice Address - Country:US
Practice Address - Phone:140-773-0324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA32100225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPTA32100OtherSTATE OF FLORIDA