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NPI Code Detail

MEDICARE: MADISON SANDRA MARTIN PT

MEDICARE: MADISON SANDRA MARTIN PT
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
1225100000XPhysical Therapist2305215422VA

General Provider Information

NPI Number : 1427765312
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADISON SANDRA MARTIN PT
Provider Business Mailing Address
First Line : 43 FENWICK RD
Second Line :
City : FORT MONROE
State : VA
Zip : 23651-1006
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 250 JOSEPHS DR
Second Line :
City : YORKTOWN
State : VA
Zip : 23693-3405
Country : US
Telephone Number : 734-717-0978
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2022
Last Update Date : 11/01/2022

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