Provider Demographics
NPI:1740679133
Name:MARTINE, HEATHER ELAINE (PTA)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ELAINE
Last Name:MARTINE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:ELAINE
Other - Last Name:TANNEHILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:8461 LAKE FOREST DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-3077
Mailing Address - Country:US
Mailing Address - Phone:530-227-6194
Mailing Address - Fax:
Practice Address - Street 1:600 SUNRISE AVE
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4110
Practice Address - Country:US
Practice Address - Phone:916-782-3131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8361225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant