Provider Demographics
NPI:1689298358
Name:MARTINEZ, YVONNE X (LMT)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:X
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7322 GWEN CT
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-1175
Mailing Address - Country:US
Mailing Address - Phone:419-690-9929
Mailing Address - Fax:
Practice Address - Street 1:415 CONANT ST STE 103
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-3388
Practice Address - Country:US
Practice Address - Phone:419-690-9299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.023124225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist