Provider Demographics
NPI:1326180175
Name:MARTINEZ, PATRICIA DONOVAN (PT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:DONOVAN
Last Name:MARTINEZ
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:PO BOX 1355
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95473-1355
Mailing Address - Country:US
Mailing Address - Phone:707-829-3282
Mailing Address - Fax:707-829-3287
Practice Address - Street 1:100 PLEASANT HILL AVE N
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-3104
Practice Address - Country:US
Practice Address - Phone:707-829-3282
Practice Address - Fax:707-829-3287
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT13313225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ07609ZOtherBLUE SHIELD PROVIDER NUMB
CAZZZ07609ZOtherBLUE SHIELD PROVIDER NUMB
CAOPT133130Medicare PIN