MEDICARE: CAROLINA MORA MARTINEZ

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	225100000X	Physical Therapist
2	208100000X	Physical Medicine & Rehabilitation Physician	1038008	TX

General Provider Information

NPI Number	:	1639638208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINA MORA MARTINEZ

Provider Business Mailing Address
First Line	:	6300 WESTPARK DR STE 212
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-7207
Country	:	US
Telephone Number	:	713-339-2273
Fax Number	:	713-339-1130

Provider Business Practice Location Address
First Line	:	6300 WESTPARK DR STE 212
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-7207
Country	:	US
Telephone Number	:	713-339-2273
Fax Number	:	713-339-1130

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

Provider Enumeration Date	:	03/13/2019
Last Update Date	:	03/29/2023

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Directions to “ CAROLINA MORA MARTINEZ ” Practice Location

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