Provider Demographics
NPI:1659046241
Name:MARTINEZ, ONERGIS EMMANUEL (PTA)
Entity type:Individual
Prefix:
First Name:ONERGIS
Middle Name:EMMANUEL
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 W WASHINGTON AVE APT 501
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-4777
Mailing Address - Country:US
Mailing Address - Phone:262-729-7149
Mailing Address - Fax:
Practice Address - Street 1:100 S 1ST ST
Practice Address - Street 2:
Practice Address - City:MOUNT HOREB
Practice Address - State:WI
Practice Address - Zip Code:53572-1906
Practice Address - Country:US
Practice Address - Phone:608-924-6018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI225200000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant