Provider Demographics
NPI:1689923781
Name:MARTIN, DEBORAH L (LMT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:MARTIN
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 1:149 ORCHARD GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044
Mailing Address - Country:US
Mailing Address - Phone:814-574-5019
Mailing Address - Fax:
Practice Address - Street 1:45 SERENITY LANE
Practice Address - Street 2:JACK'S CREEK ROAD
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044
Practice Address - Country:US
Practice Address - Phone:717-248-8847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG006497225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist