Healthcare Provider Details

I. General information

NPI: 1154463842
Provider Name (Legal Business Name): LINDA S MARTINIC PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 N CALIFORNIA ST
SOCORRO NM
87801-0642
US

IV. Provider business mailing address

602 FINCH AVENUE
SOCORRO NM
87801
US

V. Phone/Fax

Practice location:
  • Phone: 505-838-0800
  • Fax: 505-838-3999
Mailing address:
  • Phone: 505-838-0800
  • Fax: 505-838-3999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number587
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: