Provider Demographics
NPI:1932512027
Name:MARTIN, MICHELE (PTA)
Entity Type:Individual
Prefix:
First Name:MICHELE
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 1:6422 NW 70TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66618-4104
Mailing Address - Country:US
Mailing Address - Phone:785-207-2355
Mailing Address - Fax:
Practice Address - Street 1:5220 SW 17TH ST
Practice Address - Street 2:130
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-2500
Practice Address - Country:US
Practice Address - Phone:785-271-5533
Practice Address - Fax:785-271-8818
Is Sole Proprietor?:No
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-03954225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant