Provider Demographics
NPI:1578448114
Name:ORTIZ, WALTER JR
Entity type:Individual
Prefix:MR
First Name:WALTER
Middle Name:
Last Name:ORTIZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 MALACHITE LN
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-6318
Mailing Address - Country:US
Mailing Address - Phone:619-852-9724
Mailing Address - Fax:
Practice Address - Street 1:564 MALACHITE LN
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-6318
Practice Address - Country:US
Practice Address - Phone:619-852-9724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14140225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist