Provider Demographics
NPI:1922600634
Name:MARTINEZ, SARA E (LPTA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:E
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:ELIZABETH
Other - Last Name:GUTIERRES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPTA
Mailing Address - Street 1:900 W 17TH ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003
Mailing Address - Country:US
Mailing Address - Phone:719-948-7910
Mailing Address - Fax:
Practice Address - Street 1:100 SAN CARLOS RD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-2651
Practice Address - Country:US
Practice Address - Phone:719-564-2370
Practice Address - Fax:303-484-8747
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0012484225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant