Provider Demographics
NPI:1639638208
Name:MARTINEZ, CAROLINA MORA
Entity Type:Individual
Prefix:
First Name:CAROLINA
Middle Name:MORA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 WESTPARK DR STE 212
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-7207
Mailing Address - Country:US
Mailing Address - Phone:713-339-2273
Mailing Address - Fax:713-339-1130
Practice Address - Street 1:6300 WESTPARK DR STE 212
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-7207
Practice Address - Country:US
Practice Address - Phone:713-339-2273
Practice Address - Fax:713-339-1130
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
TX1038008208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation