Provider Demographics
NPI:1861909582
Name:ORTA, AIMEE (LMT)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:
Last Name:ORTA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6161 N NEOLA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-2544
Mailing Address - Country:US
Mailing Address - Phone:773-699-6686
Mailing Address - Fax:
Practice Address - Street 1:7646 W TOUHY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-4249
Practice Address - Country:US
Practice Address - Phone:773-699-6686
Practice Address - Fax:773-699-6686
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227001033225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist