Provider Demographics
NPI:1083382287
Name:MARTINEZ, PRISCILLA (PT, DPT, ATC)
Entity Type:Individual
Prefix:MS
First Name:PRISCILLA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:MS
Other - First Name:PRISCILLA
Other - Middle Name:
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:703 GRANITE ST STE 3
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-5350
Mailing Address - Country:US
Mailing Address - Phone:781-961-3370
Mailing Address - Fax:
Practice Address - Street 1:284 MONPONSETT ST STE 102
Practice Address - Street 2:
Practice Address - City:HALIFAX
Practice Address - State:MA
Practice Address - Zip Code:02338-1431
Practice Address - Country:US
Practice Address - Phone:781-293-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25675225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist