MEDICARE: MRS. GLENY GRACE 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	010649	GA
2	225100000X	Physical Therapist	12789	SC

General Provider Information

NPI Number	:	1942457213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GLENY GRACE MARTINEZ PT

Provider Business Mailing Address
First Line	:	25 CASSIDY DR
Second Line	:
City	:	BLUFFTON
State	:	SC
Zip	:	29910-4143
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 CASSIDY DR
Second Line	:
City	:	BLUFFTON
State	:	SC
Zip	:	29910-4143
Country	:	US
Telephone Number	:	843-396-1065
Fax Number	:

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

Provider Enumeration Date	:	08/19/2008
Last Update Date	:	05/26/2026

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