MEDICARE: PAULA 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	160004264	IL
2	225200000X	Physical Therapy Assistant	06003298A	IN

General Provider Information

NPI Number	:	1811241086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA MARTIN PTA

Provider Business Mailing Address
First Line	:	116 BREWER RD
Second Line	:
City	:	DANVILLE
State	:	IL
Zip	:	61834-5814
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 BREWER RD
Second Line	:
City	:	DANVILLE
State	:	IL
Zip	:	61834-5814
Country	:	US
Telephone Number	:	217-355-4120
Fax Number	:

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

Provider Enumeration Date	:	11/09/2012
Last Update Date	:	11/09/2012

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Directions to “ PAULA MARTIN PTA” Practice Location

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