Individual
MR. MARVIN LAWRENCE VIVAS MARTINEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
260 HOSPITAL DR, SOUTH WILLIAMSON, KY 41503-4072
(606) 237-1717
Mailing address
52 TOLER LOOP APT 2, BELFRY, KY 41514-8692
(917) 584-5629
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
007402
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007402
KENTUCKY BOARD OF PHYSICAL THERAPY
KY
Enumeration date
07/16/2019
Last updated
07/16/2019
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