Provider Demographics
NPI:1053099937
Name:MARTINEZ, SAM (DPT)
Entity type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7849 TRAMWAY BLVD NE STE A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-2529
Mailing Address - Country:US
Mailing Address - Phone:505-821-3831
Mailing Address - Fax:505-212-0786
Practice Address - Street 1:1540 TRAMWAY BLVD NE STE CDE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-6194
Practice Address - Country:US
Practice Address - Phone:505-872-2276
Practice Address - Fax:505-212-6158
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM2159225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist