Provider Demographics
NPI:1003045741
Name:PEDERSON-MARTINEZ PLLC
Entity Type:Organization
Organization Name:PEDERSON-MARTINEZ PLLC
Other - Org Name:OPS REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:MARLON
Authorized Official - Last Name:PEDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-585-9889
Mailing Address - Street 1:123 W. MILE 3 RD
Mailing Address - Street 2:STE A-103
Mailing Address - City:PALMHURST
Mailing Address - State:TX
Mailing Address - Zip Code:78573
Mailing Address - Country:US
Mailing Address - Phone:956-585-9889
Mailing Address - Fax:956-585-9896
Practice Address - Street 1:123 W. MILE 3 RD
Practice Address - Street 2:STE A-103
Practice Address - City:PALMHURST
Practice Address - State:TX
Practice Address - Zip Code:78573
Practice Address - Country:US
Practice Address - Phone:956-585-9889
Practice Address - Fax:956-585-9896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-02
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)