Provider Demographics
NPI:1508091497
Name:MARTINEZ, DONNA LYNNE (PT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:LYNNE
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 1:3525 SPAULDING AVE.
Mailing Address - Street 2:PRO THERAPY
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008
Mailing Address - Country:US
Mailing Address - Phone:719-542-4444
Mailing Address - Fax:719-543-1990
Practice Address - Street 1:3525 SPAULDING AVE.
Practice Address - Street 2:PRO THERAPY
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008
Practice Address - Country:US
Practice Address - Phone:719-542-4444
Practice Address - Fax:719-543-1990
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2658225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist