MEDICARE: BLADIMIR CORTEZ

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	225200000X	Physical Therapy Assistant	0031571	NY

General Provider Information

NPI Number	:	1952695413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLADIMIR CORTEZ

Provider Business Mailing Address
First Line	:	8711 35TH AVE APT 2L
Second Line	:
City	:	JACKSON HTS
State	:	NY
Zip	:	11372-5632
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8711 35TH AVE APT 2L
Second Line	:
City	:	JACKSON HTS
State	:	NY
Zip	:	11372-5632
Country	:	US
Telephone Number	:	347-524-9396
Fax Number	:

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

Provider Enumeration Date	:	06/01/2011
Last Update Date	:	06/01/2011

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Directions to “ BLADIMIR CORTEZ ” Practice Location

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