Provider Demographics
NPI:1821708603
Name:QUIRE, MARTIN HUGHES II (LMT)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:HUGHES
Last Name:QUIRE
Suffix:II
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4025 WOODRUFF AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-1775
Mailing Address - Country:US
Mailing Address - Phone:812-697-1309
Mailing Address - Fax:
Practice Address - Street 1:4025 WOODRUFF AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1775
Practice Address - Country:US
Practice Address - Phone:812-697-1309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY239910225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist