Provider Demographics
NPI:1689695348
Name:MARTIN, JOY SUZANN (DPT)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:SUZANN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 BLAZING STAR DR
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLA
Mailing Address - State:IL
Mailing Address - Zip Code:60046-9012
Mailing Address - Country:US
Mailing Address - Phone:847-863-3901
Mailing Address - Fax:
Practice Address - Street 1:656 BLAZING STAR DR
Practice Address - Street 2:
Practice Address - City:LAKE VILLA
Practice Address - State:IL
Practice Address - Zip Code:60046-9012
Practice Address - Country:US
Practice Address - Phone:847-863-3901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL70-013168225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
209349Medicare ID - Type Unspecified