Provider Demographics
NPI:1134572589
Name:MARTINEZ, JORGE (LAT, ATC)
Entity type:Individual
Prefix:MR
First Name:JORGE
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 LAKE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-3403
Mailing Address - Country:US
Mailing Address - Phone:940-497-6176
Mailing Address - Fax:
Practice Address - Street 1:3016 PARKRIDGE DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76210-2228
Practice Address - Country:US
Practice Address - Phone:940-497-6176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT36142255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer