Healthcare Provider Details

I. General information

NPI: 1427591072
Provider Name (Legal Business Name): MARTINA CIFIELLO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2016
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 JOHNSON FERRY RD STE 130
MARIETTA GA
30068-5418
US

IV. Provider business mailing address

8823 PRODUCTION LN
OOLTEWAH TN
37363-6511
US

V. Phone/Fax

Practice location:
  • Phone: 770-565-3201
  • Fax: 770-565-3203
Mailing address:
  • Phone: 423-238-7217
  • Fax: 423-362-8684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT012182
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: