Individual
DR. IVAN JOHN ORTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
2015 N BRIDGE ST, ELKIN, NC 28621
(336) 258-8252
(336) 258-8253
Mailing address
2015 N BRIDGE ST, ELKIN, NC 28621-2107
(336) 258-8252
(336) 258-8253
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4862
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
128K3
BCBS
NC
01
—
7718203
AETNA
NC
Enumeration date
11/23/2005
Last updated
06/15/2018
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