MEDICARE: ERIK F MARTINEZ PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	070019295	IL

General Provider Information

NPI Number	:	1184971699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIK F MARTINEZ PT, DPT

Provider Business Mailing Address
First Line	:	939 W MADISON ST
Second Line	:	STE. 103
City	:	CHICAGO
State	:	IL
Zip	:	60607-2638
Country	:	US
Telephone Number	:	312-243-9350
Fax Number	:	773-913-0602

Provider Business Practice Location Address
First Line	:	939 W MADISON ST
Second Line	:	STE. 103
City	:	CHICAGO
State	:	IL
Zip	:	60607-2638
Country	:	US
Telephone Number	:	312-243-9350
Fax Number	:	773-913-0602

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2012
Last Update Date	:	08/15/2012

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