Healthcare Provider Details

I. General information

NPI: 1851590731
Provider Name (Legal Business Name): ROBERTO J MARTINEZ P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1448 N KROME AVE
FLORIDA CITY FL
33034-2401
US

IV. Provider business mailing address

4483 NW 36TH ST SUITE 120
MIAMI SPRINGS FL
33166-7260
US

V. Phone/Fax

Practice location:
  • Phone: 305-245-0222
  • Fax: 305-245-6212
Mailing address:
  • Phone: 305-888-7555
  • Fax: 305-888-7410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 16631
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: