Provider Demographics
NPI:1154463842
Name:MARTINIC, LINDA S (PT)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:S
Last Name:MARTINIC
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 FINCH AVENUE
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:NM
Mailing Address - Zip Code:87801
Mailing Address - Country:US
Mailing Address - Phone:505-838-0800
Mailing Address - Fax:505-838-3999
Practice Address - Street 1:1115 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:NM
Practice Address - Zip Code:87801-0642
Practice Address - Country:US
Practice Address - Phone:505-838-0800
Practice Address - Fax:505-838-3999
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM587225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM88722520OtherMEDICAID PCO
NMD4005Medicaid
NM00P3051OtherMEDICAID-ASC