Provider Demographics
NPI:1992086656
Name:CORTEZ, JOHNNY ALAN JR (PTA)
Entity type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:ALAN
Last Name:CORTEZ
Suffix:JR
Gender:M
Credentials:PTA
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Mailing Address - Street 1:1715 CAPE CORAL PKWY W
Mailing Address - Street 2:SUITE 13
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-6914
Mailing Address - Country:US
Mailing Address - Phone:239-542-0900
Mailing Address - Fax:239-542-1802
Practice Address - Street 1:1715 CAPE CORAL PKWY W
Practice Address - Street 2:SUITE 13
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-6914
Practice Address - Country:US
Practice Address - Phone:239-542-0900
Practice Address - Fax:239-542-1802
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPTA22840225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant