Provider Demographics
NPI:1447690003
Name:MARTIE, DEBORAH (PT)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:MARTIE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WINDSOR PATH
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9617
Mailing Address - Country:US
Mailing Address - Phone:502-863-1674
Mailing Address - Fax:502-863-1676
Practice Address - Street 1:101 WINDSOR PATH
Practice Address - Street 2:SUITE 2
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9617
Practice Address - Country:US
Practice Address - Phone:502-863-1674
Practice Address - Fax:502-863-1676
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY002763225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist