Provider Demographics
NPI:1124728092
Name:MARTIN, LAMARTHA
Entity type:Individual
Prefix:
First Name:LAMARTHA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1841 RIVER HERITAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22026-2822
Mailing Address - Country:US
Mailing Address - Phone:703-785-1237
Mailing Address - Fax:
Practice Address - Street 1:14605 POTOMAC BRANCH DR STE 300
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3337
Practice Address - Country:US
Practice Address - Phone:703-490-1112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant