Provider Demographics
NPI:1053117978
Name:MARTIN, JANE (PTA)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 MORRIS FARM LN
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-5172
Mailing Address - Country:US
Mailing Address - Phone:980-999-2369
Mailing Address - Fax:
Practice Address - Street 1:6001 MORRIS FARM LN
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-5172
Practice Address - Country:US
Practice Address - Phone:980-999-2369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA8554225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant