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General NPI Number Information
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NPI Number | 1780709774
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Entity Type | Individual
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Provider Name | ANNA MAE MARTIN PTA
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Gender | Female
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 03/23/2016
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Provider Practice Location Address
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Address Line | 3033 SARNO RD
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City | MELBOURNE
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State | FL
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Zip | 32934-7229
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Country | US
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Telephone | 321-610-8979
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Fax |
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Provider Business Mailing Address
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Address Line | 2954 CHIPPER DR NE
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City | PALM BAY
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State | FL
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Zip | 32905-5705
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Country | US
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Telephone | 321-557-5728
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Fax |
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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 | PTA 18514
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2306602044
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 8067
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 05869
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License Number State | OH
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Taxonomy #5
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A2919
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License Number State | MD
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