Provider Demographics
NPI:1063443307
Name:PAULSON, MARTHA ANN (PT)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:ANN
Last Name:PAULSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:MARTI
Other - Middle Name:
Other - Last Name:PAULSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:2969 PUTNAM BLVD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4649
Mailing Address - Country:US
Mailing Address - Phone:925-935-5527
Mailing Address - Fax:925-935-4772
Practice Address - Street 1:2969 PUTNAM BLVD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4649
Practice Address - Country:US
Practice Address - Phone:925-935-5527
Practice Address - Fax:925-935-4772
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 5555225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist