Healthcare Provider Details

I. General information

NPI: 1104062322
Provider Name (Legal Business Name): MAYULLIS MARIA ORTIZ PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2008
Last Update Date: 12/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 71ST STREET
MIAMI BEACH FL
33141
US

IV. Provider business mailing address

309 71ST STREET
MIAMI BEACH FL
33141
US

V. Phone/Fax

Practice location:
  • Phone: 305-867-3925
  • Fax: 305-867-3927
Mailing address:
  • Phone: 305-867-3925
  • Fax: 305-867-3927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 20886
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: