Provider Demographics
NPI:1689671208
Name:MARTIN, LATONYA PATRECE (PT)
Entity Type:Individual
Prefix:MRS
First Name:LATONYA
Middle Name:PATRECE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27993 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:410-543-1011
Mailing Address - Fax:410-543-9061
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:410-543-1011
Practice Address - Fax:410-543-9061
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ100018592251G0304X
MD175152251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics