Provider Demographics
NPI:1780992156
Name:MARTINEZ, ELVIN (MSPT)
Entity type:Individual
Prefix:
First Name:ELVIN
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HACIENDA EL PILAR
Mailing Address - Street 2:2002 CALLE REYNA MORA
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:939-202-4441
Mailing Address - Fax:787-998-9191
Practice Address - Street 1:CALLE 14 C40
Practice Address - Street 2:TOA ALTA HEIGHTS
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-232-4503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist