Healthcare Provider Details

I. General information

NPI: 1124508932
Provider Name (Legal Business Name): MELINDA ORTIZ-FLORES PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 LOOP 459
MATHIS TX
78368-1804
US

IV. Provider business mailing address

1220 LOOP 459
MATHIS TX
78368-1804
US

V. Phone/Fax

Practice location:
  • Phone: 361-371-9093
  • Fax: 361-371-9093
Mailing address:
  • Phone: 361-547-3318
  • Fax: 361-547-3737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2050440
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: