Healthcare Provider Details

I. General information

NPI: 1154158640
Provider Name (Legal Business Name): STEFANY LUZ ORTIZ DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 W MALLARD CREEK CHURCH RD
CHARLOTTE NC
28262-2324
US

IV. Provider business mailing address

PO BOX 601791
CHARLOTTE NC
28260-1791
US

V. Phone/Fax

Practice location:
  • Phone: 704-323-2108
  • Fax: 704-323-2199
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP23521
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: