Provider Demographics
NPI:1407287857
Name:MARTIN, STEPHANIE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:GREENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:261 COMMONWEALTH AVE
Mailing Address - Street 2:APT 9
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-1631
Mailing Address - Country:US
Mailing Address - Phone:912-596-4618
Mailing Address - Fax:617-491-4411
Practice Address - Street 1:1 KENDALL SQ
Practice Address - Street 2:BUILDING 400
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1562
Practice Address - Country:US
Practice Address - Phone:617-491-0264
Practice Address - Fax:617-491-4411
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-11
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20856225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist