Individual
ALEX MARTYNENKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1109 CHURCH ST, COLLEYVILLE, TX 76034-5849
(817) 498-3919
(817) 498-7080
Mailing address
1109 CHURCH ST, COLLEYVILLE, TX 76034-5849
(817) 498-3919
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
1404068
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1404068
STATE LICENSE
TX
Enumeration date
02/11/2025
Last updated
02/11/2025
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