Healthcare Provider Details

I. General information

NPI: 1184970915
Provider Name (Legal Business Name): PIA MICHELLE MARTINY DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2012
Last Update Date: 01/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 OAK PARK DR STE101
FORT COLLINS CO
80525-6273
US

IV. Provider business mailing address

1674 FALCON RIDGE DR
FORT COLLINS CO
80528-5108
US

V. Phone/Fax

Practice location:
  • Phone: 970-206-1868
  • Fax:
Mailing address:
  • Phone: 714-875-2675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number60255702
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: