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General NPI Number Information
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NPI Number | 1851344055
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Entity Type | Individual
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Provider Name | SANDRA JEAN ORTEGA PHYSICAL THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | GATEWAY HEALTH CENTER 801 S. 70TH ST,
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City | WEST ALLIS
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State | WI
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Zip | 53214
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Country | US
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Telephone | 414-773-6631
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Fax | 414-773-6635
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Provider Business Mailing Address
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Address Line | W228S5055 MILL CT
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City | WAUKESHA
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State | WI
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Zip | 53189-9737
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Country | US
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Telephone | 262-513-8692
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2705-024
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License Number State | WI
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