Provider Demographics
NPI:1831275262
Name:MARTINEZ, MICHAEL ANGELO (LAT, ATC, NASM-PES)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ANGELO
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:LAT, ATC, NASM-PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3492 N TILLOTSON AVE APT 48
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-1794
Mailing Address - Country:US
Mailing Address - Phone:562-773-7338
Mailing Address - Fax:
Practice Address - Street 1:3492 N TILLOTSON AVE APT 48
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-1794
Practice Address - Country:US
Practice Address - Phone:562-773-7338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer