Provider Demographics
NPI:1336450436
Name:BASS, MARTHA ANN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:ANN
Last Name:BASS
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 1:6210 E TWIN PEAK CIR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-4848
Mailing Address - Country:US
Mailing Address - Phone:714-974-5553
Mailing Address - Fax:714-283-1896
Practice Address - Street 1:6210 E TWIN PEAK CIR
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-4848
Practice Address - Country:US
Practice Address - Phone:714-974-5553
Practice Address - Fax:714-283-1896
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 7143171W00000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No172V00000XOther Service ProvidersCommunity Health Worker