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General NPI Number Information
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NPI Number | 1801302435
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Entity Type | Organization
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Legal Business Name | MARTES PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 12/19/2017
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Last Update Date | 12/19/2017
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Provider Practice Location Address
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Address Line | 3747 77TH ST
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-6629
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Country | US
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Telephone | 718-406-9588
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Fax |
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Provider Business Mailing Address
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Address Line | 3109 NEWTOWN AVE STE 211
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City | ASTORIA
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State | NY
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Zip | 11102-1373
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. EDGARDO RAFAEL MARTES
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Credential | PHYSICAL THERAPIST
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Telephone | 347-924-2771
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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 | 017574
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License Number State | NY
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