Provider Demographics
NPI:1528042488
Name:MARTINEZ, ROBERT (MPT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24630 WASHINGTON AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-6177
Mailing Address - Country:US
Mailing Address - Phone:951-696-9353
Mailing Address - Fax:951-973-7216
Practice Address - Street 1:521 E ELDER ST
Practice Address - Street 2:STE 106
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3081
Practice Address - Country:US
Practice Address - Phone:760-723-8337
Practice Address - Fax:760-723-5476
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT30065225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0206905OtherWA DEPT OF LABOR
CAWPT30065AOtherMEDICARE PTAN
CAP00279574OtherRR MEDICARE