Provider Demographics
NPI:1245529049
Name:MARTINEZ, MANUEL A (LMT)
Entity type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:A
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E SLIGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-5547
Mailing Address - Country:US
Mailing Address - Phone:813-644-6805
Mailing Address - Fax:813-644-6875
Practice Address - Street 1:215 E SLIGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-5547
Practice Address - Country:US
Practice Address - Phone:813-644-6805
Practice Address - Fax:813-644-6875
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA61514225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist