1720433782 NPI number — MR. DAVID CAMILO ORTIZ-BARAJAS PHYSICAL THERAPIST

Table of content: MR. DAVID CAMILO ORTIZ-BARAJAS PHYSICAL THERAPIST (NPI 1720433782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720433782 NPI number — MR. DAVID CAMILO ORTIZ-BARAJAS PHYSICAL THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ORTIZ-BARAJAS
Provider First Name:
DAVID
Provider Middle Name:
CAMILO
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PHYSICAL THERAPIST
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720433782
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 111090
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAPLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34108-0119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-254-7778
Provider Business Mailing Address Fax Number:
855-959-1692

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1660 MEDICAL BLVD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34110-1416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-514-1708
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/27/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT 28814 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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