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NPI Code Detail

MEDICARE: DR. CARRI S MARTINE P.T.,D.P.T.

MEDICARE: DR. CARRI S MARTINE P.T.,D.P.T.
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
1225100000XPhysical Therapist2716NV

General Provider Information

NPI Number : 1104175728
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CARRI S MARTINE P.T.,D.P.T.
Provider Business Mailing Address
First Line : 3777 PECOS MCLEOD
Second Line : SUITE 102
City : LAS VEGAS
State : NV
Zip : 89121-4264
Country : US
Telephone Number : 702-731-6873
Fax Number : 702-731-2565
Provider Business Practice Location Address
First Line : 3777 PECOS MCLEOD
Second Line : SUITE 102
City : LAS VEGAS
State : NV
Zip : 89121-4264
Country : US
Telephone Number : 702-731-6873
Fax Number : 702-731-2565
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2012
Last Update Date : 08/29/2012

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