Provider Demographics
NPI:1861790685
Name:MARTENS, AUTUMN (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:MARTENS
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21302 ENCINO COMMONS
Mailing Address - Street 2:8304
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-2719
Mailing Address - Country:US
Mailing Address - Phone:562-221-4269
Mailing Address - Fax:
Practice Address - Street 1:15502 HUEBNER RD
Practice Address - Street 2:113
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-0998
Practice Address - Country:US
Practice Address - Phone:210-479-3334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3109843225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist