Provider Demographics
NPI:1396287074
Name:MARTINEZ, EVA DOROTHY (MS ATC, LAT)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:DOROTHY
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MS ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 KANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601-5532
Mailing Address - Country:US
Mailing Address - Phone:989-980-7065
Mailing Address - Fax:
Practice Address - Street 1:10039 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:STE. L
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-4010
Practice Address - Country:US
Practice Address - Phone:410-988-4319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00009232255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer