Basic Information
| Provider Information | |||||||||
| NPI: | 1497006357 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTEENY | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | P.T.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 LEXINGTON GREEN LN | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327711013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076880070 | ||||||||
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| Practice Location | |||||||||
| Address1: | 401 VENTURE DR STE C | ||||||||
| Address2: | |||||||||
| City: | SOUTH DAYTONA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321193475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3867630084 | ||||||||
| FaxNumber: | 3867630085 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2012 | ||||||||
| LastUpdateDate: | 10/01/2012 | ||||||||
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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 | 23503 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.