Provider Demographics
NPI:1265857783
Name:MARTINTONI, JANAE (PT)
Entity Type:Individual
Prefix:
First Name:JANAE
Middle Name:
Last Name:MARTINTONI
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 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-983-3825
Mailing Address - Fax:765-983-3237
Practice Address - Street 1:550 HALLMARK DR
Practice Address - Street 2:REID EATON FAMILY & SPECIALTY CARE
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-8648
Practice Address - Country:US
Practice Address - Phone:765-983-3825
Practice Address - Fax:765-983-3237
Is Sole Proprietor?:No
Enumeration Date:2014-02-20
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008311A225100000X
OHPT011188225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0117590Medicaid
IN201265380Medicaid
IN000000907865OtherANTHEM
OHH454000Medicare PIN
OH0117590Medicaid