Provider Demographics
NPI:1588836357
Name:ANDERSON, MARTIN RICHARDS
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:RICHARDS
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 EGMONT ST APT 6
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-6825
Mailing Address - Country:US
Mailing Address - Phone:617-738-0091
Mailing Address - Fax:
Practice Address - Street 1:74 EGMONT ST APT 6
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-6825
Practice Address - Country:US
Practice Address - Phone:617-738-0091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist