Provider Demographics
NPI:1841517026
Name:MICHAEL MARTINES PHYSICAL THERAPIST,
Entity type:Organization
Organization Name:MICHAEL MARTINES PHYSICAL THERAPIST,
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:MARTINES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:559-439-2002
Mailing Address - Street 1:6710 N WEST AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-4300
Mailing Address - Country:US
Mailing Address - Phone:559-439-2002
Mailing Address - Fax:559-439-2266
Practice Address - Street 1:6710 N WEST AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-4300
Practice Address - Country:US
Practice Address - Phone:559-439-2002
Practice Address - Fax:559-439-2266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-27
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X
CAPT32442261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy