Provider Demographics
NPI:1851809610
Name:MARTINEZ, MATTHEW (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
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 1:60 HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-2815
Mailing Address - Country:US
Mailing Address - Phone:210-313-1974
Mailing Address - Fax:
Practice Address - Street 1:60 HARVARD AVE
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-2815
Practice Address - Country:US
Practice Address - Phone:617-433-8482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-15
Last Update Date:2024-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22485225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist