MEDICARE: OMMAR ORTUVIA PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1186243	TX

General Provider Information

NPI Number	:	1336617299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OMMAR ORTUVIA PT

Provider Business Mailing Address
First Line	:	16427 JADESTONE TERRACE LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77044-1167
Country	:	US
Telephone Number	:	832-328-8972
Fax Number	:

Provider Business Practice Location Address
First Line	:	19298 W LAKE HOUSTON PKWY STE 240
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77346-4827
Country	:	US
Telephone Number	:	832-828-4990
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2018
Last Update Date	:	11/08/2018

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Directions to “ OMMAR ORTUVIA PT” Practice Location

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