Provider Demographics
NPI:1659163269
Name:MARTINEZ, CHRISTIAN OMAR
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:OMAR
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2070 E PLANK RD UNIT 2
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-7052
Mailing Address - Country:US
Mailing Address - Phone:920-944-5905
Mailing Address - Fax:
Practice Address - Street 1:N16W23217 STONE RIDGE DR STE 350
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1171
Practice Address - Country:US
Practice Address - Phone:844-206-4930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4261-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant