Provider Demographics
NPI:1588413397
Name:MARTIN, CARLEE ANNMARIE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:CARLEE
Middle Name:ANNMARIE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13190 SE 162ND AVE APT 217
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97015-3780
Mailing Address - Country:US
Mailing Address - Phone:509-823-7126
Mailing Address - Fax:
Practice Address - Street 1:2808 E BURNSIDE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1830
Practice Address - Country:US
Practice Address - Phone:503-477-4802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR65285225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist