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NPI Code Detail

MEDICARE: MARTHA M WATRY PT, CERT .M.D.T.

MEDICARE: MARTHA M WATRY PT, CERT .M.D.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 Therapist1356NV
2225100000XPhysical Therapist5100OR

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 : 1497736433
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTHA M WATRY PT, CERT .M.D.T.
Provider Business Mailing Address
First Line : 1610 ROBB DR STE D5
Second Line :
City : RENO
State : NV
Zip : 89523-3520
Country : US
Telephone Number : 775-746-9222
Fax Number : 775-746-9224
Provider Business Practice Location Address
First Line : 1610 ROBB DR STE D5
Second Line :
City : RENO
State : NV
Zip : 89523-3520
Country : US
Telephone Number : 775-746-9222
Fax Number : 775-746-9224
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2005
Last Update Date : 01/11/2012

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