Provider Demographics
NPI:1699154856
Name:MARTIN, ALESIA KATE (PTA)
Entity type:Individual
Prefix:MRS
First Name:ALESIA
Middle Name:KATE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 WHIPPOORWILL CIR
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-6447
Mailing Address - Country:US
Mailing Address - Phone:912-674-0890
Mailing Address - Fax:
Practice Address - Street 1:805 DILWORTH ST
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-8673
Practice Address - Country:US
Practice Address - Phone:912-882-4281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA002083225200000X
VA2306604104225200000X
FLPTA21227225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant