Provider Demographics
NPI:1457422040
Name:MARTIN, HEIDI (DPT)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:688 WESTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-6375
Mailing Address - Country:US
Mailing Address - Phone:201-666-9100
Mailing Address - Fax:201-666-9102
Practice Address - Street 1:688 WESTWOOD AVE
Practice Address - Street 2:
Practice Address - City:RIVERVALE
Practice Address - State:NJ
Practice Address - Zip Code:07675-6375
Practice Address - Country:US
Practice Address - Phone:201-666-9100
Practice Address - Fax:201-666-9102
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00582400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist