MEDICARE: NATALIE MARTINO

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	2255A2300X	Athletic Trainer	2000025505	TX

General Provider Information

NPI Number	:	1790224111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE MARTINO

Provider Business Mailing Address
First Line	:	920 ROCKDALE ROAD
Second Line	:	APT 9
City	:	SULPHUR SPRINGS
State	:	TX
Zip	:	75482
Country	:	US
Telephone Number	:	936-250-1299
Fax Number	:

Provider Business Practice Location Address
First Line	:	920 ROCKDALE RD
Second Line	:	APT 9
City	:	SULPHUR SPRINGS
State	:	TX
Zip	:	75482-3778
Country	:	US
Telephone Number	:	936-250-1299
Fax Number	:

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

Provider Enumeration Date	:	02/17/2017
Last Update Date	:	02/17/2017

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