Provider Demographics
NPI:1750784591
Name:MARTINEZ, TARA (DPT)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 S ATLANTIC BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-4700
Mailing Address - Country:US
Mailing Address - Phone:626-282-3577
Mailing Address - Fax:626-284-4276
Practice Address - Street 1:880 S ATLANTIC BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-4700
Practice Address - Country:US
Practice Address - Phone:626-282-3577
Practice Address - Fax:626-284-4276
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 35043225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist