Provider Demographics
NPI:1659931533
Name:MARTIN, ERIN BETHANY (PT, DPT)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:BETHANY
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:BETHANY
Other - Last Name:MANDZEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:
Practice Address - Street 1:1640 N WELLS ST UNIT 105
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-6006
Practice Address - Country:US
Practice Address - Phone:312-642-8114
Practice Address - Fax:312-642-8504
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.024356225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist