Provider Demographics
NPI:1134242902
Name:HEARNE, MARTHA ELLEN (PTA CLT)
Entity type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:ELLEN
Last Name:HEARNE
Suffix:
Gender:F
Credentials:PTA CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3148
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27895-3148
Mailing Address - Country:US
Mailing Address - Phone:252-243-9629
Mailing Address - Fax:252-243-0915
Practice Address - Street 1:1803 FOREST HILLS ROAD
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893
Practice Address - Country:US
Practice Address - Phone:252-243-9629
Practice Address - Fax:252-243-0915
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3474225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant