Healthcare Provider Details

I. General information

NPI: 1386552040
Provider Name (Legal Business Name): MARYCARMEN ORTIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY C ORTIZ PT, DPT, CLT

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 EST MARIA ANTONIA
GUANICA PR
00653
US

IV. Provider business mailing address

747 EST MARIA ANTONIA
GUANICA PR
00653
US

V. Phone/Fax

Practice location:
  • Phone: 787-519-0709
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4705
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: