Provider Demographics
NPI:1689223737
Name:MARTIN, ELISSA BENTLEY (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:ELISSA
Middle Name:BENTLEY
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7009 ARCOLA DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-8757
Mailing Address - Country:US
Mailing Address - Phone:469-525-6222
Mailing Address - Fax:
Practice Address - Street 1:6020 W PARKER RD STE 200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8172
Practice Address - Country:US
Practice Address - Phone:972-608-5011
Practice Address - Fax:972-608-5029
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1286356225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist