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General NPI Number Information
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NPI Number | 1710615356
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Entity Type | Individual
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Provider Name | JUSTIN BLAS MARTINEZ PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 08/11/2022
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Last Update Date | 08/11/2022
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Provider Practice Location Address
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Address Line | 160 CONGRESS PARK DR
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City | DELRAY BEACH
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State | FL
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Zip | 33445-4724
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Country | US
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Telephone | 954-701-6968
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Fax |
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Provider Business Mailing Address
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Address Line | 817 SE 2ND AVE APT 104
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-1042
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Country | US
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Telephone | 954-701-6968
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 39075
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License Number State | FL
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