Provider Demographics
NPI:1285730564
Name:MARTINEZ, STACY G (MPT, MTC)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:G
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MPT, MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6386
Mailing Address - Country:US
Mailing Address - Phone:813-877-1930
Mailing Address - Fax:813-877-1938
Practice Address - Street 1:6117 GUNN HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-4013
Practice Address - Country:US
Practice Address - Phone:813-978-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 18581225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT 18581OtherPHYSICAL THERAPIST