Provider Demographics
NPI:1831282136
Name:MARTIN, MICHELLE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10995 ALLISONVILLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-2616
Mailing Address - Country:US
Mailing Address - Phone:317-845-9628
Mailing Address - Fax:317-845-9740
Practice Address - Street 1:10995 ALLISONVILLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2616
Practice Address - Country:US
Practice Address - Phone:317-845-9628
Practice Address - Fax:317-845-9740
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN3062225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN156529Medicare ID - Type Unspecified