Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 3180 | NE |
NPI | 1003160904 |
---|---|
Provider Name | Maria Martinez |
First Address | Lone Tree, CO 80124-6732 |
Second Address | Lone Tree, CO 80124-6732 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2012 |
Last Update Date | 13/11/2014 |