Provider Demographics
NPI:1689671067
Name:MARTIN, STEPHEN EDWARD (PT)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:EDWARD
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SNOW HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21863-1054
Mailing Address - Country:US
Mailing Address - Phone:443-234-5074
Mailing Address - Fax:443-234-5087
Practice Address - Street 1:200 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SNOW HILL
Practice Address - State:MD
Practice Address - Zip Code:21863-1054
Practice Address - Country:US
Practice Address - Phone:443-234-5074
Practice Address - Fax:443-234-5087
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2015-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD176742251E1200X, 2251X0800X
DEJ100009662251E1200X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251E1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistErgonomics