Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2159576 | TX |
NPI | 1013506054 |
---|---|
Provider Name | Micaela Luisa Martinez |
First Address | Andrews, TX 79714-3841 |
Second Address | Denver City, TX 79323-3000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2021 |
Last Update Date | 14/01/2021 |