Provider Demographics
NPI:1093358632
Name:ANHALT, MARTHA JO (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:JO
Last Name:ANHALT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:MARTHA
Other - Middle Name:JO
Other - Last Name:ANHALT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:107 CEDAR BLUFF COURT
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-8119
Mailing Address - Country:US
Mailing Address - Phone:254-223-2482
Mailing Address - Fax:
Practice Address - Street 1:107 CEDAR BLUFF COURT
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-8119
Practice Address - Country:US
Practice Address - Phone:254-223-2482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-27
Last Update Date:2019-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2061942225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant