Provider Demographics
NPI:1982908059
Name:MARTINEZ, JOHANA
Entity Type:Individual
Prefix:
First Name:JOHANA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1859 GRAND BAY CIR APT 204
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-1918
Mailing Address - Country:US
Mailing Address - Phone:863-272-0752
Mailing Address - Fax:
Practice Address - Street 1:708 PEARL CIR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4246
Practice Address - Country:US
Practice Address - Phone:813-391-0235
Practice Address - Fax:813-655-4814
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist