Provider Demographics
NPI:1639851546
Name:MARTINEZ, CIERRA MARIE
Entity Type:Individual
Prefix:DR
First Name:CIERRA
Middle Name:MARIE
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 1:4543 CHARLOTTE HWY STE 11
Mailing Address - Street 2:
Mailing Address - City:CLOVER
Mailing Address - State:SC
Mailing Address - Zip Code:29710-7057
Mailing Address - Country:US
Mailing Address - Phone:803-831-1454
Mailing Address - Fax:803-831-1555
Practice Address - Street 1:4543 CHARLOTTE HWY STE 11
Practice Address - Street 2:
Practice Address - City:CLOVER
Practice Address - State:SC
Practice Address - Zip Code:29710-7057
Practice Address - Country:US
Practice Address - Phone:803-831-1454
Practice Address - Fax:803-831-1555
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10462225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist