Provider Demographics
NPI:1174002109
Name:MARTINEZ, MARIA R (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:R
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 TOURNAMENT TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6564
Mailing Address - Country:US
Mailing Address - Phone:956-727-3422
Mailing Address - Fax:
Practice Address - Street 1:1701 TOURNAMENT TRAIL DR
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6564
Practice Address - Country:US
Practice Address - Phone:956-727-3422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211862225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant