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General NPI Number Information
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NPI Number | 1134572589
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Entity Type | Individual
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Provider Name | JORGE MARTINEZ LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 07/21/2016
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Last Update Date | 07/21/2016
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Provider Practice Location Address
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Address Line | 3016 PARKRIDGE DR
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City | CORINTH
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State | TX
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Zip | 76210-2228
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Country | US
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Telephone | 940-497-6176
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Fax |
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Provider Business Mailing Address
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Address Line | 2709 LAKE RIDGE DR
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City | LITTLE ELM
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State | TX
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Zip | 75068-3403
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Country | US
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Telephone | 940-497-6176
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT3614
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License Number State | TX
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