Healthcare Provider Details

I. General information

NPI: 1962837492
Provider Name (Legal Business Name): JEFFREY GEORGE MARTINI PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2013
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6921 W ARCHER AVE
CHICAGO IL
60638-2319
US

IV. Provider business mailing address

8603 S DIXIE HWY STE 308
PINECREST FL
33156-1129
US

V. Phone/Fax

Practice location:
  • Phone: 773-586-2768
  • Fax:
Mailing address:
  • Phone: 305-661-1441
  • Fax: 305-661-1443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.020242
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: