Provider Demographics
NPI:1881137164
Name:MARTIN, ANDREW RYAN (PT, DPT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:RYAN
Last Name:MARTIN
Suffix:
Gender:M
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 1:117 S HALCYON RD
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3115
Mailing Address - Country:US
Mailing Address - Phone:805-481-5656
Mailing Address - Fax:
Practice Address - Street 1:117 S HALCYON RD
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3115
Practice Address - Country:US
Practice Address - Phone:805-481-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-18
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT013129225100000X
WI13658-24225100000X
CAPT295371225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist