Provider Demographics
NPI:1285775395
Name:MATTOX, MARTHA MINJARES (PT)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:MINJARES
Last Name:MATTOX
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 MONTGOMERY ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-3402
Mailing Address - Country:US
Mailing Address - Phone:415-986-4979
Mailing Address - Fax:415-986-6951
Practice Address - Street 1:220 MONTGOMERY ST
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-3402
Practice Address - Country:US
Practice Address - Phone:415-986-4979
Practice Address - Fax:415-986-6951
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 8284174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist