Provider Demographics
NPI:1043584931
Name:FROHWEIN, MARTHA J (PT)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:J
Last Name:FROHWEIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3052 S CORAL CT
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-4830
Mailing Address - Country:US
Mailing Address - Phone:605-376-2871
Mailing Address - Fax:
Practice Address - Street 1:4500 S PRINCE OF PEACE PL
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103-5830
Practice Address - Country:US
Practice Address - Phone:605-322-5618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-24
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0280225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1043584931Medicaid
SD1043584931Medicaid