Provider Demographics
NPI:1710740113
Name:MARTIN, DANETTE DAWN
Entity Type:Individual
Prefix:
First Name:DANETTE
Middle Name:DAWN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6906 ECKMANSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45697-9743
Mailing Address - Country:US
Mailing Address - Phone:513-405-0613
Mailing Address - Fax:
Practice Address - Street 1:5280 US HIGHWAY 62 AND 68
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:OH
Practice Address - Zip Code:45167-8650
Practice Address - Country:US
Practice Address - Phone:513-405-0613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH05298225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant