MEDICARE: AMANDA MARTIN PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	A3594	MD

General Provider Information

NPI Number	:	1417254301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA MARTIN PTA

Provider Business Mailing Address
First Line	:	15625 WOODLAND POINT RD
Second Line	:
City	:	NEWBURG
State	:	MD
Zip	:	20664-6304
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15625 WOODLAND POINT RD
Second Line	:
City	:	NEWBURG
State	:	MD
Zip	:	20664-6304
Country	:	US
Telephone Number	:	240-210-4075
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2011
Last Update Date	:	02/11/2011

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Directions to “ AMANDA MARTIN PTA” Practice Location

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