Provider Demographics
NPI:1649724196
Name:MARTINEZ, ANDY (PT)
Entity type:Individual
Prefix:
First Name:ANDY
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 KOONTZ LN
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-5513
Mailing Address - Country:US
Mailing Address - Phone:775-883-3622
Mailing Address - Fax:
Practice Address - Street 1:201 KOONTZ LN
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-5513
Practice Address - Country:US
Practice Address - Phone:775-883-3622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHCP000117T225100000X
TX1278612225100000X
NV3650225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist