Provider Demographics
NPI:1669767398
Name:MARTIS, ELISSA LEANDRA (DPT)
Entity type:Individual
Prefix:
First Name:ELISSA
Middle Name:LEANDRA
Last Name:MARTIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 SE 5TH CT
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-8465
Mailing Address - Country:US
Mailing Address - Phone:561-965-2126
Mailing Address - Fax:561-965-0316
Practice Address - Street 1:360 SE 5TH CT
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-8465
Practice Address - Country:US
Practice Address - Phone:561-965-2126
Practice Address - Fax:561-965-0316
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT26014225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist