Provider Demographics
NPI:1558366112
Name:FOXEN, MARTIN FRANCIS (PT)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:FRANCIS
Last Name:FOXEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 MAURA KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-9064
Mailing Address - Country:US
Mailing Address - Phone:319-366-2279
Mailing Address - Fax:
Practice Address - Street 1:1825 29TH ST NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-3452
Practice Address - Country:US
Practice Address - Phone:319-362-6994
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2712225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA48286OtherWELLMARK
IA0241125Medicaid
IA0241125Medicaid