Provider Demographics
NPI:1790297125
Name:MARTINEZ, DANYA (PT, PCS)
Entity Type:Individual
Prefix:
First Name:DANYA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PT, PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 BELVIDERE ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-1830
Mailing Address - Country:US
Mailing Address - Phone:915-241-2782
Mailing Address - Fax:
Practice Address - Street 1:119 LUNA ST SE
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-6814
Practice Address - Country:US
Practice Address - Phone:505-865-9636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics