Healthcare Provider Details

I. General information

NPI: 1558195784
Provider Name (Legal Business Name): JENNIFER ORTIZ LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5602 176TH ST E STE G102103
PUYALLUP WA
98375-9307
US

IV. Provider business mailing address

18328 71ST AVE E
PUYALLUP WA
98375-1843
US

V. Phone/Fax

Practice location:
  • Phone: 253-495-7188
  • Fax: 253-271-0445
Mailing address:
  • Phone: 253-678-9777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00020960
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: