Provider Demographics
NPI:1942207568
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
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:866-860-6983
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
Practice Address - Country:US
Practice Address - Phone:443-234-5074
Practice Address - Fax:866-860-6983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-29
Last Update Date:2018-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X, 225X00000X
DE225100000X
MD225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1821045345Medicaid
MD4873OtherCAREFIRST BLUE CROSS BLUE SHIELD
DE700290OtherUNITED HEALTH CARE
MD0530OtherWORKMANS COMPENSATION
MD311903OtherAMERIGROUP
DE5705311OtherFIRST HEALTH / CCN
DEDF1647OtherRAIL ROAD MEDICARE
MD311903OtherAMERIGROUP