Provider Demographics
NPI:1457672479
Name:ALTIMAR, MARTIN J (MSPT)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:J
Last Name:ALTIMAR
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:SINKING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:19608-9789
Mailing Address - Country:US
Mailing Address - Phone:610-670-5256
Mailing Address - Fax:
Practice Address - Street 1:47 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:SINKING SPRING
Practice Address - State:PA
Practice Address - Zip Code:19608-9789
Practice Address - Country:US
Practice Address - Phone:610-670-5256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT009289225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist