Provider Demographics
NPI:1801840582
Name:MARTIN, ALICIA CAROL (ATC/L)
Entity type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:CAROL
Last Name:MARTIN
Suffix:
Gender:F
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:417 LACKEY RD
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-5727
Mailing Address - Country:US
Mailing Address - Phone:731-414-7531
Mailing Address - Fax:
Practice Address - Street 1:VANDERBILT SPORTS MEDICINE,
Practice Address - Street 2:215 HAWKS RD. SUITE 12
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237
Practice Address - Country:US
Practice Address - Phone:731-587-6299
Practice Address - Fax:731-587-5392
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000008572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer