Provider Demographics
NPI:1770707697
Name:MARTIN, GAIL CHARMAINE (PT)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:CHARMAINE
Last Name:MARTIN
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:GAIL
Other - Middle Name:CHARMAINE
Other - Last Name:ALCANTARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 1772
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32588-1772
Mailing Address - Country:US
Mailing Address - Phone:850-897-7772
Mailing Address - Fax:888-308-1539
Practice Address - Street 1:4554 E HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-9755
Practice Address - Country:US
Practice Address - Phone:850-897-7772
Practice Address - Fax:888-308-1539
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017164225100000X
FLPT29220225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106733Medicare PIN