Provider Demographics
NPI:1326388786
Name:MARTIN, DAVID E (PTA, DPT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PTA, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5120 DIXIE HWY STE 102
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-1775
Mailing Address - Country:US
Mailing Address - Phone:502-448-0931
Mailing Address - Fax:502-448-0918
Practice Address - Street 1:5120 DIXIE HWY STE 102
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-1775
Practice Address - Country:US
Practice Address - Phone:502-448-0931
Practice Address - Fax:502-448-0918
Is Sole Proprietor?:No
Enumeration Date:2013-02-22
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA02869225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant