Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA00234 | RI |
NPI | 1023134343 |
---|---|
Provider Name | Mrs. Debra Ann Martin |
First Address | Westport, MA 02790-1813 |
Second Address | Middletown, RI 02842-5620 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 08/07/2007 |