Provider Demographics
NPI:1275691263
Name:MARTIN, MARJORIE SUE (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARJORIE
Middle Name:SUE
Last Name:MARTIN
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 1:6221 ANTLER HILL DRIVE
Mailing Address - Street 2:
Mailing Address - City:TRAFFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15085
Mailing Address - Country:US
Mailing Address - Phone:412-980-3137
Mailing Address - Fax:
Practice Address - Street 1:711 BINGHAM ST.
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15203
Practice Address - Country:US
Practice Address - Phone:724-304-0030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT002244E225100000X
2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist