Individual
AMANDA TILTON MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
56 OLD FARM RD, STOWE, VT 05672-4434
(802) 253-6852
Mailing address
3251 VT ROUTE 109, WATERVILLE, VT 05492-9518
(802) 644-6364
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
040-0003034
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1009723
—
VT
Enumeration date
11/29/2006
Last updated
07/08/2007
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