Provider Demographics
NPI:1003317397
Name:MARTINEZ HUERTA, JORGE ISAAC (LMT, CNMT)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:ISAAC
Last Name:MARTINEZ HUERTA
Suffix:
Gender:M
Credentials:LMT, CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 ALPINE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-2117
Mailing Address - Country:US
Mailing Address - Phone:719-377-7299
Mailing Address - Fax:
Practice Address - Street 1:487 WINDCHIME PL STE 314
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-1933
Practice Address - Country:US
Practice Address - Phone:719-377-7299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0018844225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist