Healthcare Provider Details

I. General information

NPI: 1942457213
Provider Name (Legal Business Name): GLENY GRACE MARTINEZ PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 CASSIDY DR
BLUFFTON SC
29910-4143
US

IV. Provider business mailing address

25 CASSIDY DR
BLUFFTON SC
29910-4143
US

V. Phone/Fax

Practice location:
  • Phone: 843-396-1065
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number010649
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12789
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: