Provider Demographics
NPI:1841611548
Name:MARTEENY, MICHAEL (PTA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MARTEENY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 OLEANDER AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-3433
Mailing Address - Country:US
Mailing Address - Phone:386-265-2275
Mailing Address - Fax:386-492-2987
Practice Address - Street 1:4550 S CLYDE MORRIS BLVD
Practice Address - Street 2:STE. D
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-5294
Practice Address - Country:US
Practice Address - Phone:386-492-2986
Practice Address - Fax:386-492-2987
Is Sole Proprietor?:No
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24586225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant