Healthcare Provider Details

I. General information

NPI: 1003790825
Provider Name (Legal Business Name): LUZ DANIELA LARRAGA MARTINEZ DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3360 GATEWAY RD
BROOKFIELD WI
53045-5115
US

IV. Provider business mailing address

917 2ND ST
MONROE WI
53566-1104
US

V. Phone/Fax

Practice location:
  • Phone: 262-923-7101
  • Fax:
Mailing address:
  • Phone: 608-807-7699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: