Provider Demographics
NPI:1568802072
Name:MARTINEZ, ANDREA MICHELLE (DPT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MICHELLE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:MICHELLE
Other - Last Name:GUZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:400 CONCORD PLAZA DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6991
Mailing Address - Country:US
Mailing Address - Phone:210-804-6448
Mailing Address - Fax:210-804-5674
Practice Address - Street 1:5000 SCHERTZ PKWY STE 600
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-1457
Practice Address - Country:US
Practice Address - Phone:210-804-6448
Practice Address - Fax:210-804-5674
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1231916225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01228430Medicare PIN
TX300801YTUHMedicare PIN
TXP01228430Medicare PIN
TX300801YTUHMedicare PIN
TX327431801Medicaid