Provider Demographics
NPI:1780840389
Name:MARTIN, EARL D (PT)
Entity Type:Individual
Prefix:MR
First Name:EARL
Middle Name:D
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 1:808 S GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:PHILO
Mailing Address - State:IL
Mailing Address - Zip Code:61864-9784
Mailing Address - Country:US
Mailing Address - Phone:217-684-2157
Mailing Address - Fax:
Practice Address - Street 1:808 S GARFIELD ST
Practice Address - Street 2:
Practice Address - City:PHILO
Practice Address - State:IL
Practice Address - Zip Code:61864-9784
Practice Address - Country:US
Practice Address - Phone:217-684-2157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-03
Last Update Date:2008-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070005266225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist