Provider Demographics
NPI:1205341773
Name:LONG, MARTHA CHRISTINE (PTA)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:CHRISTINE
Last Name:LONG
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 SENIOR DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15227-3740
Mailing Address - Country:US
Mailing Address - Phone:814-758-8829
Mailing Address - Fax:
Practice Address - Street 1:36 OLD HICKORY RIDGE RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-8613
Practice Address - Country:US
Practice Address - Phone:724-228-5010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI000873208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation