Provider Demographics
NPI:1790776896
Name:MARTINEZ, VIVEAN MARIET (PT)
Entity Type:Individual
Prefix:MS
First Name:VIVEAN
Middle Name:MARIET
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 CALLE PORTO MAYOR
Mailing Address - Street 2:PORTOBELLO
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-5402
Mailing Address - Country:US
Mailing Address - Phone:787-210-4940
Mailing Address - Fax:787-730-0161
Practice Address - Street 1:COND RIVER PARK PARK
Practice Address - Street 2:I-105
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-8500
Practice Address - Country:US
Practice Address - Phone:787-786-6155
Practice Address - Fax:787-786-6155
Is Sole Proprietor?:No
Enumeration Date:2005-10-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1165225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR005-6794Medicare ID - Type UnspecifiedPROVIDER NUMBER
PRQ-26019Medicare UPIN