Basic Information
| Provider Information | |||||||||
| NPI: | 1376935718 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTINEZ | ||||||||
| FirstName: | REYNALDO | ||||||||
| MiddleName: | OSCAR | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8868 RESEARCH BLVD | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787586497 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5126153000 | ||||||||
| FaxNumber: | 5126153001 | ||||||||
| Practice Location | |||||||||
| Address1: | 8868 RESEARCH BLVD | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787586497 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5126153000 | ||||||||
| FaxNumber: | 5126153001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2015 | ||||||||
| LastUpdateDate: | 02/23/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 2049890 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.