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General NPI Number Information
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NPI Number | 1245403005
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Entity Type | Individual
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Provider Name | ASHLEY N MARTIN PTA
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Gender | Female
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Dates
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Enumeration Date | 04/11/2008
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Last Update Date | 04/11/2008
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Provider Practice Location Address
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Address Line | 4339 ROOSEVELT BLVD STE 600
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City | JACKSONVILLE
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State | FL
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Zip | 32210-2000
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Country | US
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Telephone | 904-389-8570
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Fax | 904-389-8599
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Provider Business Mailing Address
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Address Line | 1325 SAN MARCO BLVD STE 200 ATTN: CREDENTIALING
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8566
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Country | US
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Telephone | 904-346-3465
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Fax | 904-858-6490
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA21212
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License Number State | FL
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