Provider Demographics
NPI:1790239812
Name:MARTINEZ-TIBERI, AMELIAH E (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:AMELIAH
Middle Name:E
Last Name:MARTINEZ-TIBERI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 51319
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33994-1119
Mailing Address - Country:US
Mailing Address - Phone:239-334-6160
Mailing Address - Fax:239-334-1339
Practice Address - Street 1:1650 MEDICAL LN STE 4
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1116
Practice Address - Country:US
Practice Address - Phone:239-334-6160
Practice Address - Fax:239-334-1339
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60668046225100000X
FLPT32522225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023295800Medicaid