Provider Demographics
NPI:1922253285
Name:MARTIN, CINDY KAY (PT)
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:KAY
Last Name:MARTIN
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 1:2010 MELROSE PL
Mailing Address - Street 2:
Mailing Address - City:KATHLEEN
Mailing Address - State:GA
Mailing Address - Zip Code:31047-2874
Mailing Address - Country:US
Mailing Address - Phone:478-972-0358
Mailing Address - Fax:
Practice Address - Street 1:1030 PEACH PKWY
Practice Address - Street 2:SUITE 8
Practice Address - City:FORT VALLEY
Practice Address - State:GA
Practice Address - Zip Code:31030-8181
Practice Address - Country:US
Practice Address - Phone:478-822-9809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-28
Last Update Date:2012-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT005659225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist