Provider Demographics
NPI:1619297926
Name:MARTINOVIC, SASA (PT)
Entity type:Individual
Prefix:
First Name:SASA
Middle Name:
Last Name:MARTINOVIC
Suffix:
Gender:M
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:PO BOX 530062
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-0062
Mailing Address - Country:US
Mailing Address - Phone:843-695-6071
Mailing Address - Fax:843-569-5879
Practice Address - Street 1:2500 ELMS CENTER RD # B
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406
Practice Address - Country:US
Practice Address - Phone:843-572-7727
Practice Address - Fax:843-569-5881
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9385225100000X
TN8649225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN9770617OtherCIGNA
TNP00884970OtherRR MEDICARE
SCTH3750Medicaid
TN1520518Medicaid
TN4269164OtherBLUECROSS BLUESHIELD
9668744OtherAETNA