Provider Demographics
NPI:1316248636
Name:MARTINEZ, RUDY
Entity type:Individual
Prefix:MR
First Name:RUDY
Middle Name:
Last Name:MARTINEZ
Suffix:
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 1:12700 HILLCREST RD STE 245
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2070
Mailing Address - Country:US
Mailing Address - Phone:972-503-1110
Mailing Address - Fax:
Practice Address - Street 1:12700 HILLCREST RD STE 245
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2070
Practice Address - Country:US
Practice Address - Phone:972-503-1110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT002675225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX225700000TXOtherMASSAGE THERAPIST