Provider Demographics
NPI:1619367851
Name:ZEANCHOCK, MARTINA LYNN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:MARTINA
Middle Name:LYNN
Last Name:ZEANCHOCK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 BACK RD
Mailing Address - Street 2:
Mailing Address - City:CARROLLTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15722-8503
Mailing Address - Country:US
Mailing Address - Phone:814-244-0495
Mailing Address - Fax:
Practice Address - Street 1:540 BACK RD
Practice Address - Street 2:
Practice Address - City:CARROLLTOWN
Practice Address - State:PA
Practice Address - Zip Code:15722-8503
Practice Address - Country:US
Practice Address - Phone:814-244-0495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG007248172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist