Doctor Name: | PAUL G MARTINO |
NPI Number: | 1144458381 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 1631 |
Business Practice Address: | 2166 Gold Hill Rd Ste B Tega Cay, SC - 297088384 |
Business Phone Number: | 8038025508 |
Business Fax Number: | |
Mailing Address: | 7349 Windyrush Rd, CHARLOTTE |
State: | NC |
Postal Code: | 282263111 |
Phone Number: | 7045624770 |
Fax Number: | |
NPI Enumeration Date: | 06/25/2009 |
NPI Last Update Date: | 06/25/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251P0200X |
License Number: | 1631 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SC |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |