Provider Demographics
NPI:1558119115
Name:ORTIZ, JOSE L (LMT)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:L
Last Name:ORTIZ
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 1:2324 W SHAKESPEARE AVE APT 2F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-4377
Mailing Address - Country:US
Mailing Address - Phone:773-209-5290
Mailing Address - Fax:
Practice Address - Street 1:2324 W SHAKESPEARE AVE APT 2F
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-4377
Practice Address - Country:US
Practice Address - Phone:773-209-5290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227016958225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist