Provider Demographics
NPI:1801897624
Name:HUTTON, MARTINE G (PT)
Entity type:Individual
Prefix:MS
First Name:MARTINE
Middle Name:G
Last Name:HUTTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:MARTINE
Other - Middle Name:G
Other - Last Name:MANDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:680 W NYE LN
Mailing Address - Street 2:STE 205
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-1500
Mailing Address - Country:US
Mailing Address - Phone:775-882-2211
Mailing Address - Fax:
Practice Address - Street 1:680 W NYE LN
Practice Address - Street 2:SUITE 205
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-1575
Practice Address - Country:US
Practice Address - Phone:775-882-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1521225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003413203Medicaid
NV003413203Medicaid