Healthcare Provider Details

I. General information

NPI: 1164291761
Provider Name (Legal Business Name): JOSEPH MARTINEZ PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2023
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23511 HOLLYWOOD RD
LEONARDTOWN MD
20650-5833
US

IV. Provider business mailing address

45579 BETHFIELD WAY
CALIFORNIA MD
20619-2372
US

V. Phone/Fax

Practice location:
  • Phone: 240-577-6433
  • Fax:
Mailing address:
  • Phone: 240-561-1321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number23518
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number23518
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: