Provider Demographics
NPI:1689182404
Name:MARTIN, JOANNA A (DPT)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:A
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:JOANNA
Other - Middle Name:A
Other - Last Name:COGIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:54945 MOUND RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-6028
Mailing Address - Country:US
Mailing Address - Phone:586-992-1500
Mailing Address - Fax:586-992-8050
Practice Address - Street 1:54945 MOUND RD
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-6028
Practice Address - Country:US
Practice Address - Phone:586-992-1500
Practice Address - Fax:586-992-8050
Is Sole Proprietor?:No
Enumeration Date:2018-01-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501018545225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist