Healthcare Provider Details

I. General information

NPI: 1013395631
Provider Name (Legal Business Name): AMANDA E MARTIN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 05/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 MERRIMON AVE STE 107
ASHEVILLE NC
28804-3456
US

IV. Provider business mailing address

PO BOX 18806
ASHEVILLE NC
28814-0806
US

V. Phone/Fax

Practice location:
  • Phone: 828-348-1780
  • Fax: 877-922-4820
Mailing address:
  • Phone: 828-348-1780
  • Fax: 877-922-4820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT13861
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT13861
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: