Healthcare Provider Details

I. General information

NPI: 1598520827
Provider Name (Legal Business Name): ALYSSA MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2024
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 ROBINSON RD
OLD HICKORY TN
37138-3326
US

IV. Provider business mailing address

302 FOREST RETREAT RD
HENDERSONVILLE TN
37075-2056
US

V. Phone/Fax

Practice location:
  • Phone: 615-847-1502
  • Fax:
Mailing address:
  • Phone: 734-626-7564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number8225
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: