Provider Demographics
NPI:1326841784
Name:MARTINEZ-RIVERA, ESMERALDA (MT)
Entity type:Individual
Prefix:
First Name:ESMERALDA
Middle Name:
Last Name:MARTINEZ-RIVERA
Suffix:
Gender:
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 S ROGERS ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-3657
Mailing Address - Country:US
Mailing Address - Phone:812-822-7288
Mailing Address - Fax:
Practice Address - Street 1:3505 CONSTANCE AVE STE 1
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-5893
Practice Address - Country:US
Practice Address - Phone:812-310-4983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT22408413225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist