Provider Demographics
NPI:1871564906
Name:MARTIN, CAROLYN (PT)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:
Last Name:MARTIN
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 1:5975 SUNSET DR
Mailing Address - Street 2:SUITE 405
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5166
Mailing Address - Country:US
Mailing Address - Phone:305-661-8040
Mailing Address - Fax:305-661-8891
Practice Address - Street 1:5975 SUNSET DR
Practice Address - Street 2:SUITE 405
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5166
Practice Address - Country:US
Practice Address - Phone:305-661-8040
Practice Address - Fax:305-661-8891
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19325225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5614Medicare ID - Type Unspecified