Provider Demographics
NPI:1164727632
Name:MARTINEZ, DONALD JASON (ATC)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:JASON
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 1:1000 EAST UNIVERSITY AVENUE
Mailing Address - Street 2:DEPARTMENT 3414
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82071
Mailing Address - Country:US
Mailing Address - Phone:307-766-5052
Mailing Address - Fax:
Practice Address - Street 1:1000 E UNIVERSITY AVE
Practice Address - Street 2:DEPARTMENT 3414
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82071-2000
Practice Address - Country:US
Practice Address - Phone:307-766-5052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY242255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer