Provider Demographics
NPI:1023059045
Name:MARTIN, DOUGLAS JAY (MPT)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:JAY
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-3187
Mailing Address - Country:US
Mailing Address - Phone:406-375-0980
Mailing Address - Fax:406-375-9938
Practice Address - Street 1:2020 N 1ST ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-3187
Practice Address - Country:US
Practice Address - Phone:406-375-0980
Practice Address - Fax:406-375-9938
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1181225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
650018806OtherRAILROAD MEDICARE
MT0000341768Medicaid
MT60636OtherBCBS
MT0000341768Medicaid