Provider Demographics
NPI:1356747711
Name:MARTIN, PAIGE (DPT, PT, ATC, LAT)
Entity type:Individual
Prefix:DR
First Name:PAIGE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DPT, PT, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6707 CARLSBAD RIO
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78233-4580
Mailing Address - Country:US
Mailing Address - Phone:210-473-9846
Mailing Address - Fax:
Practice Address - Street 1:15316 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-0987
Practice Address - Country:US
Practice Address - Phone:210-614-4567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12481422251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics