Provider Demographics
NPI:1104837301
Name:GOTTER, MARTINA (PT , DSC)
Entity type:Individual
Prefix:DR
First Name:MARTINA
Middle Name:
Last Name:GOTTER
Suffix:
Gender:F
Credentials:PT , DSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77180 CALIFORNIA DR
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-7870
Mailing Address - Country:US
Mailing Address - Phone:408-596-0897
Mailing Address - Fax:
Practice Address - Street 1:73221 HIGHWAY 111
Practice Address - Street 2:STE A
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-3907
Practice Address - Country:US
Practice Address - Phone:760-773-2179
Practice Address - Fax:760-773-2810
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 22781225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DR766ZMedicare PIN