Basic Information
| Provider Information | |||||||||
| NPI: | 1760797328 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ORTIZ | ||||||||
| FirstName: | STACEY | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6177 RIVER CREST DR STE A | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925070728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516534480 | ||||||||
| FaxNumber: | 9516535051 | ||||||||
| Practice Location | |||||||||
| Address1: | 6177 RIVER CREST DR STE A | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925070728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516534480 | ||||||||
| FaxNumber: | 9516535051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2010 | ||||||||
| LastUpdateDate: | 02/05/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT 36975 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.