Provider Demographics
NPI:1669863304
Name:MARTIN, TAMI (PTA)
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5271 ANTHONY AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-2307
Mailing Address - Country:US
Mailing Address - Phone:714-717-1344
Mailing Address - Fax:
Practice Address - Street 1:2888 LONG BEACH BLVD
Practice Address - Street 2:SUITE 405
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1530
Practice Address - Country:US
Practice Address - Phone:562-595-4489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3613225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant