Provider Demographics
NPI:1003241761
Name:MARTINEZ, STEPHEN ANTHONY (LMT 7573)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:ANTHONY
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:LMT 7573
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6554 ANCIENTS RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-6111
Mailing Address - Country:US
Mailing Address - Phone:505-320-0690
Mailing Address - Fax:
Practice Address - Street 1:6554 ANCIENTS RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-6111
Practice Address - Country:US
Practice Address - Phone:505-320-0690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM7573225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist