Healthcare Provider Details

I. General information

NPI: 1255674677
Provider Name (Legal Business Name): GILBERT ANTHONY MARTINEZ I PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 04/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3453 IH 35 N SUITE 110
SAN ANTONIO TX
78219-2333
US

IV. Provider business mailing address

3510 STONEHAVEN DR
SAN ANTONIO TX
78230-3217
US

V. Phone/Fax

Practice location:
  • Phone: 210-226-7767
  • Fax:
Mailing address:
  • Phone: 210-286-8465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2006003
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: