Provider Demographics
NPI:1063645984
Name:MARTINEZ, MICHAEL ANTHONY (PT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:27880 RIATA RANCH DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78261-2517
Mailing Address - Country:US
Mailing Address - Phone:210-870-9430
Mailing Address - Fax:
Practice Address - Street 1:1201 N RAUL LONGORIA RD
Practice Address - Street 2:SUITE P
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-3727
Practice Address - Country:US
Practice Address - Phone:210-870-9430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1166869225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist