MEDICARE: ANN MARIE MARTIN MPT

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	225100000X	Physical Therapist	PT22152	CA

General Provider Information

NPI Number	:	1871562454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN MARIE MARTIN MPT

Provider Business Mailing Address
First Line	:	2530 OPALSTONE TER
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94903-1309
Country	:	US
Telephone Number	:	415-246-3001
Fax Number	:

Provider Business Practice Location Address
First Line	:	275 HOSPITAL PKWY
Second Line	:	STE. 765
City	:	SAN JOSE
State	:	CA
Zip	:	95119-1106
Country	:	US
Telephone Number	:	650-299-2817
Fax Number	:

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

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	12/30/2021

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