Provider Demographics
NPI:1558586537
Name:KONDAS, MARTINA DIANE (DPT)
Entity Type:Individual
Prefix:MISS
First Name:MARTINA
Middle Name:DIANE
Last Name:KONDAS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 629
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-0629
Mailing Address - Country:US
Mailing Address - Phone:843-836-7003
Mailing Address - Fax:843-836-7004
Practice Address - Street 1:847 E MAIN STREET
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214
Practice Address - Country:US
Practice Address - Phone:814-221-5390
Practice Address - Fax:814-393-6544
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11566225100000X
PAPT016467225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014338240001Medicaid