Provider Demographics
NPI:1427337203
Name:MARTINEZ, ROBERT M (PTA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 N IMPERIAL AVE
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-2329
Mailing Address - Country:US
Mailing Address - Phone:760-353-3422
Mailing Address - Fax:760-353-9163
Practice Address - Street 1:428 N IMPERIAL AVE
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-2329
Practice Address - Country:US
Practice Address - Phone:760-353-3422
Practice Address - Fax:760-353-9163
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 9355225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAT 9355OtherSTATE OF CALIFORNIA PHYSICAL THERAPY BOARD