Provider Demographics
NPI:1003121278
Name:MARTINSEN, JEREMY DAVID (DPT)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:DAVID
Last Name:MARTINSEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 ROUTE 38
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-9725
Mailing Address - Country:US
Mailing Address - Phone:856-273-8080
Mailing Address - Fax:856-273-0633
Practice Address - Street 1:3115 ROUTE 38
Practice Address - Street 2:SUITE 300
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-9725
Practice Address - Country:US
Practice Address - Phone:856-273-8080
Practice Address - Fax:856-273-0633
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01365700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist