Provider Demographics
NPI:1578599320
Name:MARTIN, RICHARD H (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:H
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2812
Mailing Address - Country:US
Mailing Address - Phone:304-599-2515
Mailing Address - Fax:304-285-3738
Practice Address - Street 1:25 MAIN ST
Practice Address - Street 2:SUITE 7
Practice Address - City:SMITHFIELD
Practice Address - State:PA
Practice Address - Zip Code:15478-8943
Practice Address - Country:US
Practice Address - Phone:724-569-4404
Practice Address - Fax:724-569-4406
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV001953225100000X
PAPT013614L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA650016284OtherRAILROAD MEDICARE
WV9420048000Medicaid
PA001720098OtherHIGHMARK BCBS
PA001720098OtherHIGHMARK BCBS