Provider Demographics
NPI:1326235490
Name:MARTZ, PATRICK JOE (PTA)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:JOE
Last Name:MARTZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 GRASSE STREET
Mailing Address - Street 2:
Mailing Address - City:CALICO ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72519-0438
Mailing Address - Country:US
Mailing Address - Phone:870-297-3726
Mailing Address - Fax:870-297-4161
Practice Address - Street 1:103 GRASSE STREET
Practice Address - Street 2:
Practice Address - City:CALICO ROCK
Practice Address - State:AR
Practice Address - Zip Code:72519-0438
Practice Address - Country:US
Practice Address - Phone:870-297-3726
Practice Address - Fax:870-297-4161
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1759225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant