Provider Demographics
NPI:1609050368
Name:MARTIN PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:MARTIN PHYSICAL THERAPY, INC
Other - Org Name:MARTIN PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, OCS
Authorized Official - Phone:410-219-5131
Mailing Address - Street 1:27993 CROSS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-2430
Mailing Address - Country:US
Mailing Address - Phone:410-219-5131
Mailing Address - Fax:410-219-5132
Practice Address - Street 1:27993 CROSS CREEK DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-2430
Practice Address - Country:US
Practice Address - Phone:410-219-5131
Practice Address - Fax:410-219-5132
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARTIN PHYSICAL THERAPY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-18
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0000966225100000X
MD17674225100000X
VA2305205546225100000X
DE225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1821045345Medicaid
MD700290OtherACN - UNITED HEALTH CARE
MD5705311OtherFIRST HEALTH / CCN
MD1821045345OtherRAIL ROAD MEDICARE
MD311903OtherAMERIGROUP MEDICAID
MD0530OtherWORKMANS COMP
DE700290OtherACN - UNITED HEALTH CARE
DE1942207568OtherRAIL ROAD MEDICARE
DE5705311OtherFIRST HEALTH / CCN
MD0530OtherWORKMANS COMP
DE5705311OtherFIRST HEALTH / CCN