Provider Demographics
NPI:1730346990
Name:MARTINEZ, TONI A (PT)
Entity type:Individual
Prefix:MRS
First Name:TONI
Middle Name:A
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1436
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-1436
Mailing Address - Country:US
Mailing Address - Phone:505-865-7955
Mailing Address - Fax:505-866-7191
Practice Address - Street 1:336 LUNA AVE
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-1436
Practice Address - Country:US
Practice Address - Phone:505-865-7955
Practice Address - Fax:505-866-7191
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM522225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM695951OtherUNITED HEALTHCARE
NMK-2312Medicaid
NM201079553OtherPRES HEALTH PLAN/SALUD
NMD0641OtherDDWAIVER
NMNM00N637OtherBCBS
NM90328OtherLOVELACE SALUD
NM32-6531Medicare PIN