Provider Demographics
NPI:1710191259
Name:MARTINEZ, VICKIE MAUREEN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:VICKIE
Middle Name:MAUREEN
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:VICKIE
Other - Middle Name:M
Other - Last Name:MARTINEZ-CORDERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:2603 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2803
Mailing Address - Country:US
Mailing Address - Phone:407-621-1106
Mailing Address - Fax:407-557-8791
Practice Address - Street 1:840 N STATE ROAD 434
Practice Address - Street 2:STE. A
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-7014
Practice Address - Country:US
Practice Address - Phone:407-621-1106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 40000172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist