Provider Demographics
NPI:1982840096
Name:MAYLAND, MARTHA DAVENPORT (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:DAVENPORT
Last Name:MAYLAND
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 CORDOBA CTR DRIVE
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71909
Mailing Address - Country:US
Mailing Address - Phone:501-922-1686
Mailing Address - Fax:501-922-9735
Practice Address - Street 1:140 CORDOBA CTR DRIVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71909
Practice Address - Country:US
Practice Address - Phone:501-922-1686
Practice Address - Fax:501-922-9735
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT311225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist