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NPI Code Detail

MEDICARE: DIANNE L MARTINEZ PTA

MEDICARE: DIANNE L MARTINEZ PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant965-19WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023068848
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANNE L MARTINEZ PTA
Provider Business Mailing Address
First Line : PO BOX 735044
Second Line :
City : CHICAGO
State : IL
Zip : 60673-5044
Country : US
Telephone Number : 920-787-6900
Fax Number :
Provider Business Practice Location Address
First Line : 900 E DIVISION ST
Second Line :
City : WAUTOMA
State : WI
Zip : 54982-6944
Country : US
Telephone Number : 920-787-6900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2006
Last Update Date : 11/29/2023

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Directions to “ DIANNE L MARTINEZ PTA” Practice Location

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