Provider Demographics
NPI:1205652773
Name:MARTINEZ, MARIZA CUAJAO (PT)
Entity type:Individual
Prefix:
First Name:MARIZA
Middle Name:CUAJAO
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 ISLE OF SKY CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-8531
Mailing Address - Country:US
Mailing Address - Phone:407-765-0399
Mailing Address - Fax:
Practice Address - Street 1:303 ISLE OF SKY CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-8531
Practice Address - Country:US
Practice Address - Phone:407-765-0399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-29
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT6915261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy