Healthcare Provider Details

I. General information

NPI: 1407254253
Provider Name (Legal Business Name): NAJA SALEEM MARTIN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2014
Last Update Date: 12/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 WEBB GIN HOUSE RD
LAWRENCEVILLE GA
30045-5440
US

IV. Provider business mailing address

1375 WEBB GIN HOUSE RD
LAWRENCEVILLE GA
30045-5440
US

V. Phone/Fax

Practice location:
  • Phone: 470-299-5013
  • Fax: 470-299-5014
Mailing address:
  • Phone: 470-299-5013
  • Fax: 470-299-5014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberPT011373
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberPT011373
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: