Provider Demographics
NPI:1215028709
Name:MARTIN, MATTHEW J (PT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PT
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:USAMEDDAC WUERZBURG ATTN: CREDENTIALS OFFICE
Mailing Address - Street 2:UNIT 26610
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09244
Mailing Address - Country:US
Mailing Address - Phone:01149931-804-3616
Mailing Address - Fax:01149931-804-3241
Practice Address - Street 1:USAMEDDAC WUERZBURG PHYSICAL THERAPY CLINIC
Practice Address - Street 2:UNIT 26610
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09244
Practice Address - Country:US
Practice Address - Phone:01149931-804-3801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT23116225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN