Provider Demographics
NPI:1851824841
Name:MARTIN, MARY ANN (MPT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6128 E 38TH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-5808
Mailing Address - Country:US
Mailing Address - Phone:918-835-8691
Mailing Address - Fax:918-836-4505
Practice Address - Street 1:6128 E 38TH ST STE 400
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-5808
Practice Address - Country:US
Practice Address - Phone:918-835-8691
Practice Address - Fax:918-836-4505
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK41272251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics