MEDICARE: JAVIER MARTIN PRO PT

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	PT6756	FL

General Provider Information

NPI Number	:	1649326794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAVIER MARTIN PRO PT

Provider Business Mailing Address
First Line	:	17003 S.W. 79 PLACE
Second Line	:
City	:	VILLAGE OF PALMETTO BAY
State	:	FL
Zip	:	33157
Country	:	US
Telephone Number	:	305-968-1849
Fax Number	:	786-242-8269

Provider Business Practice Location Address
First Line	:	300 SEVILLA AVE
Second Line	:	304
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-6636
Country	:	US
Telephone Number	:	305-445-4224
Fax Number	:	305-445-4224

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

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	07/08/2007

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