Individual
THOMAS MATT MARTINEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPTA
Contact information
Practice address
2701 CALIFORNIA ST, PUEBLO, CO 81004-3869
(719) 561-1300
Mailing address
3107 W 27TH ST, PUEBLO, CO 81003-1027
(719) 994-3375
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
PTA.0012129
CO
225200000X
Physical Therapy Assistant
Primary
PTA0012129
CO
Other
Enumeration date
09/06/2019
Last updated
09/06/2019
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