Provider Demographics
NPI:1053580019
Name:MARTINEZ, SHEILA DORMITORIO (PT)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:DORMITORIO
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16962 CARROTWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:52503
Mailing Address - Country:US
Mailing Address - Phone:951-343-9568
Mailing Address - Fax:
Practice Address - Street 1:16962 CARROTWOOD DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-7918
Practice Address - Country:US
Practice Address - Phone:951-343-9568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25395225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA25395OtherP.T. LICENSE