Provider Demographics
NPI:1609250984
Name:MARTINEZ, ANNELIESE FOX (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:ANNELIESE
Middle Name:FOX
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 DUKE AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-2109
Mailing Address - Country:US
Mailing Address - Phone:432-661-8374
Mailing Address - Fax:
Practice Address - Street 1:900 DUKE AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79765-2109
Practice Address - Country:US
Practice Address - Phone:432-661-8374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10311962255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer