Provider Demographics
NPI:1316023997
Name:INFANTE, MARTIN (PT)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:INFANTE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 CORPUS CHRISTI ST
Mailing Address - Street 2:A
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78040-5313
Mailing Address - Country:US
Mailing Address - Phone:956-725-5212
Mailing Address - Fax:956-725-5217
Practice Address - Street 1:1219 CORPUS CHRISTI ST
Practice Address - Street 2:A
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-5313
Practice Address - Country:US
Practice Address - Phone:956-725-5212
Practice Address - Fax:956-725-5217
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1056653225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX802T07Medicare ID - Type Unspecified