Provider Demographics
NPI:1851302327
Name:MARTIN, ANGELA JO (DPT)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:JO
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 1:322 SE 21ST TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-4378
Mailing Address - Country:US
Mailing Address - Phone:239-458-0124
Mailing Address - Fax:
Practice Address - Street 1:700 EL DORADO PKWY W
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-7232
Practice Address - Country:US
Practice Address - Phone:239-941-5441
Practice Address - Fax:239-945-5441
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6740225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist