Provider Demographics
NPI:1700916210
Name:MARTIN, ALISSA (ATC, MPT)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:ATC, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6843 N CITRUS AVE
Mailing Address - Street 2:BLDG 2, UNIT T
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34428
Mailing Address - Country:US
Mailing Address - Phone:904-718-9555
Mailing Address - Fax:352-794-3243
Practice Address - Street 1:6843 N CITRUS AVE
Practice Address - Street 2:BLDG 2, UNIT T
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34428
Practice Address - Country:US
Practice Address - Phone:352-322-6093
Practice Address - Fax:352-794-3243
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT23232225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist