Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ellen Grandaw Martin

Individual provider Physical Therapist · NPI 1902572571

Ellen Grandaw Martin is a Physical Therapist in Private Practice in Random Lake, Wisconsin. Graduated from University of Wisconsin School of Medicine in 1992, 34 years ago. Practices with Aegis Group Practice LLC, a 406-clinician group and accepts Medicare assignment. Licensed in Wisconsin.

Years since qualifying
34
Trained at
University of Wisconsin School of Medicine
Licensed in
WI
In the registry since
2021
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Practice location Address checks out

621 Spring Ct
Random Lake, WI 53075-1790
Phone: (920) 960-0505
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 4431-24 (WI)

Record details

NPI number1902572571
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedAugust 23, 2021
Last updated in NPPESAugust 23, 2021
Certification dateAugust 23, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolUNIVERSITY OF WISCONSIN SCHOOL OF MEDICINE
Graduated 1992 (34 years in practice)
Group practice Aegis Group Practice Llc — 406 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Random Lake