Individual
DIANNE L MARTINEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
900 E DIVISION ST, WAUTOMA, WI 54982-6944
(920) 787-6900
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(920) 787-6900
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
965-19
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100006660
—
WI
Enumeration date
05/11/2006
Last updated
11/29/2023
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