Healthcare Provider Details

I. General information

NPI: 1730346990
Provider Name (Legal Business Name): TONI A. MARTINEZ PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 LUNA AVE
LOS LUNAS NM
87031-1436
US

IV. Provider business mailing address

PO BOX 1436
LOS LUNAS NM
87031-1436
US

V. Phone/Fax

Practice location:
  • Phone: 505-865-7955
  • Fax: 505-866-7191
Mailing address:
  • Phone: 505-865-7955
  • Fax: 505-866-7191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number522
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: