Provider Demographics
NPI:1043630189
Name:ERLE, MARTIN (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:ERLE
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 FAIRFIELD CT
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-6606
Mailing Address - Country:US
Mailing Address - Phone:610-574-5289
Mailing Address - Fax:
Practice Address - Street 1:25 YEARSLEY MILL RD
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5522
Practice Address - Country:US
Practice Address - Phone:610-892-1296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART001387A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPROVIDER CODE 22OtherRESPIRATORY, REHABILITATIVE, & RESTORATIVE SERVICE PROVIDERS