Healthcare Provider Details

I. General information

NPI: 1801148267
Provider Name (Legal Business Name): DANIEL MARTINEZ JR. PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3302 BOCA CHICA BLVD
BROWNSVILLE TX
78521-4202
US

IV. Provider business mailing address

PO BOX 1029
OLMITO TX
78575-1029
US

V. Phone/Fax

Practice location:
  • Phone: 956-982-1001
  • Fax: 956-550-9393
Mailing address:
  • Phone: 956-982-1001
  • Fax: 956-982-1938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1221312
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: