Provider Demographics
NPI:1386662781
Name:MARTINEK, RONALD GERALD (PT)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:GERALD
Last Name:MARTINEK
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 1:20 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50428-1712
Mailing Address - Country:US
Mailing Address - Phone:641-357-0165
Mailing Address - Fax:641-357-0166
Practice Address - Street 1:20 N 8TH ST
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:IA
Practice Address - Zip Code:50428-1712
Practice Address - Country:US
Practice Address - Phone:641-357-0165
Practice Address - Fax:641-357-0166
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02267225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0733584Medicaid
IA0733584Medicaid