Provider Demographics
NPI:1376717868
Name:MARTIN PHYSICAL THERAPY AND WELLNESS, INC.
Entity Type:Organization
Organization Name:MARTIN PHYSICAL THERAPY AND WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:K
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:478-822-9808
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:FORT VALLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31030-0369
Mailing Address - Country:US
Mailing Address - Phone:478-822-9809
Mailing Address - Fax:
Practice Address - Street 1:1030 PEACH PKWY
Practice Address - Street 2:SUITE 8
Practice Address - City:FORT VALLEY
Practice Address - State:GA
Practice Address - Zip Code:31030-8181
Practice Address - Country:US
Practice Address - Phone:478-822-9809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2012-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy