Provider Demographics
NPI:1598083933
Name:MARTY, CHARLES JOSEPH (PT)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:JOSEPH
Last Name:MARTY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:3666 KEARNY VILLA RD
Mailing Address - Street 2:200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1951
Mailing Address - Country:US
Mailing Address - Phone:858-505-5400
Mailing Address - Fax:858-505-5459
Practice Address - Street 1:3666 KEARNY VILLA RD
Practice Address - Street 2:200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1951
Practice Address - Country:US
Practice Address - Phone:858-505-5400
Practice Address - Fax:858-505-5459
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPT80812251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports