Provider Demographics
NPI:1801062500
Name:MARTINEZ, JEANNIE INEZ (PT, MS)
Entity type:Individual
Prefix:MRS
First Name:JEANNIE
Middle Name:INEZ
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22914 WESTGATE VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-8161
Mailing Address - Country:US
Mailing Address - Phone:281-913-9127
Mailing Address - Fax:
Practice Address - Street 1:4500 BISSONNET ST
Practice Address - Street 2:SUITE 340
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3120
Practice Address - Country:US
Practice Address - Phone:713-838-9050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1181008225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020412200001Medicaid