Provider Demographics
NPI:1790108041
Name:MARTIN, EVA DICKINSON (DPT)
Entity Type:Individual
Prefix:MS
First Name:EVA
Middle Name:DICKINSON
Last Name:MARTIN
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 1:3669 FOXFIRE PL STE 250
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-7902
Mailing Address - Country:US
Mailing Address - Phone:706-360-4234
Mailing Address - Fax:
Practice Address - Street 1:106 PLEASANT HOME RD STE 2K
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-0510
Practice Address - Country:US
Practice Address - Phone:707-724-6543
Practice Address - Fax:206-350-9023
Is Sole Proprietor?:No
Enumeration Date:2014-01-22
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011301225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist