Provider Demographics
NPI:1083155485
Name:MARTINEZ, JOSEPH NICHOLAS (ATC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:NICHOLAS
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6590 ROCKLAND DR
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:VA
Mailing Address - Zip Code:20124-2413
Mailing Address - Country:US
Mailing Address - Phone:908-619-5424
Mailing Address - Fax:
Practice Address - Street 1:6590 ROCKLAND DRIVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:VA
Practice Address - Zip Code:20124
Practice Address - Country:US
Practice Address - Phone:908-619-5424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260025342255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer