Provider Demographics
NPI:1669099164
Name:SANDIDGE, MARTINE CHERIE (PTA)
Entity type:Individual
Prefix:
First Name:MARTINE
Middle Name:CHERIE
Last Name:SANDIDGE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29814 OAKVIEW ST
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-6488
Mailing Address - Country:US
Mailing Address - Phone:832-316-2992
Mailing Address - Fax:
Practice Address - Street 1:5600 CYPRESSWOOD DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-8691
Practice Address - Country:US
Practice Address - Phone:832-559-7767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2049410225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant