Provider Demographics
NPI:1194383778
Name:MARTIN, ANGELA M (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 EMBASSY OAKS STE 202
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-2042
Mailing Address - Country:US
Mailing Address - Phone:210-490-4738
Mailing Address - Fax:210-490-5231
Practice Address - Street 1:2130 NE LOOP 410 STE 212
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-4662
Practice Address - Country:US
Practice Address - Phone:210-656-5848
Practice Address - Fax:210-656-5847
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1318549225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty