Provider Demographics
NPI:1851326946
Name:VERTSON, MARTIN ANDREW (PT, DPT, ATC)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:ANDREW
Last Name:VERTSON
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26741 PORTOLA PKWY STE 1E-630
Mailing Address - Street 2:
Mailing Address - City:FOOTHILL RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92610-1743
Mailing Address - Country:US
Mailing Address - Phone:714-290-1209
Mailing Address - Fax:
Practice Address - Street 1:1550 NE RIDDELL RD STE 170
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3060
Practice Address - Country:US
Practice Address - Phone:360-474-3274
Practice Address - Fax:360-824-6720
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT21687225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT21687CMedicare ID - Type UnspecifiedMCARE