MEDICARE: MRS. ESTELLA MARIA MARTINEZ P.T.A.

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
1	225200000X	Physical Therapy Assistant

General Provider Information

NPI Number	:	1205176203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ESTELLA MARIA MARTINEZ P.T.A.

Provider Business Mailing Address
First Line	:	5224 N 15TH DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-3001
Country	:	US
Telephone Number	:	480-306-0480
Fax Number	:

Provider Business Practice Location Address
First Line	:	5224 N 15TH DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-3001
Country	:	US
Telephone Number	:	480-306-0480
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2013
Last Update Date	:	06/26/2014

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