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General NPI Number Information
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NPI Number | 1659163269
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Entity Type | Individual
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Provider Name | CHRISTIAN OMAR MARTINEZ
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Gender | Male
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Dates
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Enumeration Date | 05/20/2025
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | N16W23217 STONE RIDGE DR STE 350
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City | WAUKESHA
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State | WI
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Zip | 53188-1171
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Country | US
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Telephone | 844-206-4930
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Fax |
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Provider Business Mailing Address
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Address Line | 2070 E PLANK RD UNIT 2
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City | APPLETON
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State | WI
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Zip | 54915-7052
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Country | US
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Telephone | 920-944-5905
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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 | 4261-19
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License Number State | WI
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