Provider Demographics
NPI:1992411649
Name:ORTIZ, JUAN PABLO (PT, DPT)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:PABLO
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10415 STATE HIGHWAY 151 STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4553
Mailing Address - Country:US
Mailing Address - Phone:210-647-1167
Mailing Address - Fax:210-647-7229
Practice Address - Street 1:10415 STATE HIGHWAY 151 STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4553
Practice Address - Country:US
Practice Address - Phone:210-647-1167
Practice Address - Fax:210-647-7229
Is Sole Proprietor?:No
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1368627225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1368627OtherSTATE LICENSE