Provider Demographics
NPI:1649949678
Name:MARTINEZ, MARISSA (PT, DPT)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7373 PRESCOTT LN
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7884
Mailing Address - Country:US
Mailing Address - Phone:561-281-8379
Mailing Address - Fax:
Practice Address - Street 1:4971 LE CHALET BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-1418
Practice Address - Country:US
Practice Address - Phone:561-733-5590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL37643225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist