Healthcare Provider Details

I. General information

NPI: 1851348163
Provider Name (Legal Business Name): CHRISTOPHER MARTINEZ PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7125 FRANKFORD AVE
PHILADELPHIA PA
19135-1008
US

IV. Provider business mailing address

2036 LONEY ST
PHILADELPHIA PA
19152-3205
US

V. Phone/Fax

Practice location:
  • Phone: 215-338-8900
  • Fax: 215-338-8923
Mailing address:
  • Phone: 215-742-0885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberJ2-0000608
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTE002999L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: