Provider Demographics
NPI:1356838148
Name:MARTINEZ, BECKY A (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:A
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 WITTINGTON PL STE 175
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-1905
Mailing Address - Country:US
Mailing Address - Phone:866-221-5405
Mailing Address - Fax:
Practice Address - Street 1:445 HOLCOMB RANCH LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-5435
Practice Address - Country:US
Practice Address - Phone:775-851-0123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHCP000116T225100000X
OHPT017559225100000X
NV3649225100000X
TX1278447225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist