Lillian Grace Marttala, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT015959 Issued in GA

Practice address

3405 Dallas Hwy SW Ste 601
Marietta, GA 30064-6427

Phone

(770) 438-5226

NPI assigned

Jun 10, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Lilly Grace Marttala Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1654819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654819200000",
    "number": "1790415065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2361 SANFORD RD",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300335511",
            "telephone_number": "931-607-2910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3405 DALLAS HWY SW STE 601",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300646427",
            "telephone_number": "770-438-5226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTTALA",
        "first_name": "LILLIAN",
        "middle_name": "GRACE",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-10",
        "last_updated": "2022-06-10",
        "certification_date": "2022-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT015959",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LILLY",
            "last_name": "MARTTALA",
            "middle_name": "GRACE",
            "credential": "PT, DPT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Physical Therapist in Marietta, GA
• Providers in Marietta, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.