Provider Demographics
NPI:1003972456
Name:MARTIN, DEBRA (PT)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13455 VENTURA BLVD STE 212
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-6125
Mailing Address - Country:US
Mailing Address - Phone:818-528-7411
Mailing Address - Fax:818-528-7412
Practice Address - Street 1:18425 BURBANK BLVD STE 413
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-6677
Practice Address - Country:US
Practice Address - Phone:818-996-8386
Practice Address - Fax:818-996-8979
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT6392225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist