Provider Demographics
NPI:1497736433
Name:WATRY, MARTHA M (PT, CERT MDT)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:M
Last Name:WATRY
Suffix:
Gender:F
Credentials:PT, CERT MDT
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:M
Other - Last Name:DOMBROWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1610 ROBB DR STE D5
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-3520
Mailing Address - Country:US
Mailing Address - Phone:775-746-9222
Mailing Address - Fax:775-746-9224
Practice Address - Street 1:1610 ROBB DR STE D5
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-3520
Practice Address - Country:US
Practice Address - Phone:775-746-9222
Practice Address - Fax:775-746-9224
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1356225100000X
OR5100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV3416142Medicaid
NV35898Medicare ID - Type Unspecified
NV3416142Medicaid