MEDICARE: NATHAN J 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	2153	NV
2	225100000X	Physical Therapist	34422	CA

General Provider Information

NPI Number	:	1689852949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN J MARTINEZ

Provider Business Mailing Address
First Line	:	13 HIGH RD
Second Line	:
City	:	JEMEZ SPRINGS
State	:	NM
Zip	:	87025-9372
Country	:	US
Telephone Number	:	505-235-4415
Fax Number	:

Provider Business Practice Location Address
First Line	:	13 HIGH RD
Second Line	:
City	:	JEMEZ SPRINGS
State	:	NM
Zip	:	87025-9372
Country	:	US
Telephone Number	:	505-235-4415
Fax Number	:

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

Provider Enumeration Date	:	02/08/2008
Last Update Date	:	02/08/2008

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Directions to “ NATHAN J MARTINEZ ” Practice Location

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