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NPI Code Detail

MEDICARE: MR. TODD WILLIAM MARTINEZ L.M.T.

MEDICARE:  MR. TODD WILLIAM MARTINEZ  L.M.T.
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
1225700000XMassage Therapist10934OR

General Provider Information

NPI Number : 1790949311
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TODD WILLIAM MARTINEZ L.M.T.
Provider Business Mailing Address
First Line : 815 RIVER ST
Second Line :
City : PAYETTE
State : ID
Zip : 83661-2179
Country : US
Telephone Number : 208-642-8859
Fax Number :
Provider Business Practice Location Address
First Line : 815 RIVER ST
Second Line :
City : PAYETTE
State : ID
Zip : 83661-2179
Country : US
Telephone Number : 208-642-8859
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2008
Last Update Date : 07/13/2008

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Directions to “ MR. TODD WILLIAM MARTINEZ L.M.T.” Practice Location

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