Provider Demographics
NPI:1821045345
Name:MARTIN PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:MARTIN PHYSICAL THERAPY, INC
Other - Org Name:MARTIN PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, OCS
Authorized Official - Phone:443-234-5074
Mailing Address - Street 1:200 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SNOW HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21863-1054
Mailing Address - Country:US
Mailing Address - Phone:443-234-5074
Mailing Address - Fax:443-234-5087
Practice Address - Street 1:200 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SNOW HILL
Practice Address - State:MD
Practice Address - Zip Code:21863-1054
Practice Address - Country:US
Practice Address - Phone:443-234-5074
Practice Address - Fax:443-234-5087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-29
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17674225100000X, 2251E1200X, 2251X0800X
DEJ1-0000966225100000X, 2251E1200X, 2251X0800X
MD261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251E1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistErgonomicsGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0530OtherWORKMANS COMP
MD700290OtherACN - UNITED HEALTH
DEDF1647OtherRAILROAD MEDICARE
MD311903OtherAMERIGROUP
MD5705311OtherFIRST HEALTH/CCN
MD311903OtherAMERIGROUP
DEG02334Medicare UPIN