Provider Demographics
NPI:1861751786
Name:MARTINEZ, JUDY GATPO (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:JUDY
Middle Name:GATPO
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:
Other - Last Name:LOS BANOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:105 LEVERETT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-1724
Mailing Address - Country:US
Mailing Address - Phone:201-736-5790
Mailing Address - Fax:
Practice Address - Street 1:4363 AMBOY RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-3819
Practice Address - Country:US
Practice Address - Phone:917-677-5336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-12
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032417225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist