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NPI Code Detail

MEDICARE: MICHAEL ORTLIEB DPT

MEDICARE: MICHAEL ORTLIEB 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
1225100000XPhysical Therapist309141CA

General Provider Information

NPI Number : 1710840467
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL ORTLIEB DPT
Provider Business Mailing Address
First Line : 1017 10TH ST APT 14
Second Line :
City : SANTA MONICA
State : CA
Zip : 90403-4149
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3283 MOTOR AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90034-3709
Country : US
Telephone Number : 310-845-9690
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2025
Last Update Date : 12/08/2025

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