Provider Demographics
NPI:1821357385
Name:MARTINEZ, ANDREW E (PT)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:E
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 BRYANT IRVIN RD N
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-7673
Mailing Address - Country:US
Mailing Address - Phone:817-738-9866
Mailing Address - Fax:
Practice Address - Street 1:4901 BRYANT IRVIN RD N
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-7673
Practice Address - Country:US
Practice Address - Phone:817-738-9866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1073419225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist