Provider Demographics
NPI:1659046241
Name:MARTINEZ, ONERGIS EMMANUEL (PTA)
Entity Type:Individual
Prefix:
First Name:ONERGIS
Middle Name:EMMANUEL
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 PARTRIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:GENOA CITY
Mailing Address - State:WI
Mailing Address - Zip Code:53128-2520
Mailing Address - Country:US
Mailing Address - Phone:262-729-7149
Mailing Address - Fax:
Practice Address - Street 1:N6359 US HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:WI
Practice Address - Zip Code:53121-3955
Practice Address - Country:US
Practice Address - Phone:262-723-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant