Individual
GWEN MARIE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
500 HOSPITAL DR, CRESTVIEW, FL 32539-7355
(850) 398-6428
(850) 398-6507
Mailing address
500 HOSPITAL DR, CRESTVIEW, FL 32539-7355
(850) 398-6428
(850) 398-6507
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
PTA1486
AL
225200000X
Physical Therapy Assistant
Primary
PTA21573
FL
Other
Enumeration date
05/31/2012
Last updated
05/31/2012
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