Healthcare Provider Details

I. General information

NPI: 1972086965
Provider Name (Legal Business Name): CHRISTOPHER MARTINEZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2018
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 W SIMS WAY STE 101
PORT TOWNSEND WA
98368-2221
US

IV. Provider business mailing address

190 PIONEER DR
PORT LUDLOW WA
98365-9620
US

V. Phone/Fax

Practice location:
  • Phone: 208-920-2089
  • Fax:
Mailing address:
  • Phone: 208-922-0869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHRISTOPHER MARTINEZ
Title or Position: OWNER/PT
Credential: DPT
Phone: 360-379-2436