MEDICARE: MR. JOSE L ORTIZ LMT

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	225700000X	Massage Therapist	227016958	IL

General Provider Information

NPI Number	:	1558119115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSE L ORTIZ LMT

Provider Business Mailing Address
First Line	:	2324 W SHAKESPEARE AVE APT 2F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4377
Country	:	US
Telephone Number	:	773-209-5290
Fax Number	:

Provider Business Practice Location Address
First Line	:	2324 W SHAKESPEARE AVE APT 2F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4377
Country	:	US
Telephone Number	:	773-209-5290
Fax Number	:

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

Provider Enumeration Date	:	05/08/2024
Last Update Date	:	05/08/2024

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