Provider Demographics
NPI:1629142989
Name:CAMERON, MARTHA E (PT)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:E
Last Name:CAMERON
Suffix:
Gender:F
Credentials:PT
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 50681
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-0305
Mailing Address - Country:US
Mailing Address - Phone:941-228-6734
Mailing Address - Fax:
Practice Address - Street 1:13638 2ND AVE NE
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34212-2725
Practice Address - Country:US
Practice Address - Phone:941-228-6734
Practice Address - Fax:941-343-9402
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT15540225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY103EOtherBCBS OF FLORIDA
AA283ZMedicare ID - Type Unspecified