MEDICARE: MATEO J MARTINEZ 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	22123	FL

General Provider Information

NPI Number	:	1760524847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATEO J MARTINEZ PT

Provider Business Mailing Address
First Line	:	315 NE 3RD AVE
Second Line	:	APT 908
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-1631
Country	:	US
Telephone Number	:	954-993-6299
Fax Number	:

Provider Business Practice Location Address
First Line	:	2655 E OAKLAND PARK BLVD
Second Line	:	SUITE 5
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33306-1662
Country	:	US
Telephone Number	:	954-630-3131
Fax Number	:

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	02/20/2023

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