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General NPI Number Information
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NPI Number | 1013506054
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Entity Type | Individual
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Provider Name | MICAELA LUISA MARTINEZ PTA
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Gender | Female
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Dates
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Enumeration Date | 01/14/2021
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Last Update Date | 01/14/2021
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Provider Practice Location Address
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Address Line | 711 W BROADWAY ST
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City | DENVER CITY
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State | TX
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Zip | 79323-3000
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Country | US
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Telephone | 817-542-5493
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Fax |
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Provider Business Mailing Address
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Address Line | 1204 ASPEN DR APT D
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City | ANDREWS
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State | TX
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Zip | 79714-3841
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Country | US
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Telephone | 309-756-7331
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2159576
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License Number State | TX
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