Healthcare Provider Details

I. General information

NPI: 1124586391
Provider Name (Legal Business Name): MARTIN FELIZ PT,DPT,MS,ATC,CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10215 FERNWOOD RD STE 506
BETHESDA MD
20817-1184
US

IV. Provider business mailing address

224-D CORNWALL STREET, SUITE 403
LEESBURG VA
20176
US

V. Phone/Fax

Practice location:
  • Phone: 301-530-1010
  • Fax:
Mailing address:
  • Phone: 703-737-6010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305214184
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: