Healthcare Provider Details

I. General information

NPI: 1790297125
Provider Name (Legal Business Name): DANYA MARTINEZ PT, PCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2017
Last Update Date: 10/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 LUNA ST SE
LOS LUNAS NM
87031-6814
US

IV. Provider business mailing address

1217 BELVIDERE ST
EL PASO TX
79912-1830
US

V. Phone/Fax

Practice location:
  • Phone: 505-865-9636
  • Fax:
Mailing address:
  • Phone: 915-241-2782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: