Provider Demographics
NPI:1275571168
Name:EMKES, MARTA G (PT)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:G
Last Name:EMKES
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 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:154 W CARMEL DRIVE
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-2526
Practice Address - Country:US
Practice Address - Phone:317-818-0404
Practice Address - Fax:317-818-0407
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05000683A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000092827OtherANTHEM
318840EMedicare ID - Type Unspecified
IN000000092827OtherANTHEM