Individual
MS. MYDDIAM ORTIZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3651 W WATERS AVE, TAMPA, FL 33614-2783
(813) 932-5119
Mailing address
7517 CONNECTICUT DR, TAMPA, FL 33619-2033
(813) 770-7553
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
PTA11430
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MO5000
—
FL
Enumeration date
05/13/2010
Last updated
05/13/2010
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