MEDICARE: ISAMARIS ORTIZ FUENTES DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1307	PR

General Provider Information

NPI Number	:	1134138001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISAMARIS ORTIZ FUENTES DPT

Provider Business Mailing Address
First Line	:	PO BOX 2884
Second Line	:
City	:	RIO GRANDE
State	:	PR
Zip	:	00745-2800
Country	:	US
Telephone Number	:	787-887-2555
Fax Number	:	787-657-5600

Provider Business Practice Location Address
First Line	:	CALLE GARCIA DE LA NOCEDA B18
Second Line	:	VILLAS DE RIO GRANDE
City	:	RIO GRANDE
State	:	PR
Zip	:	00745-0000
Country	:	US
Telephone Number	:	787-887-2555
Fax Number	:	787-657-5600

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	12/17/2014

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