1609050368 NPI number — MARTIN PHYSICAL THERAPY, INC

Table of content: (NPI 1609050368)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609050368 NPI number — MARTIN PHYSICAL THERAPY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARTIN PHYSICAL THERAPY, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609050368
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27993 CROSS CREEK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21801-2430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-219-5131
Provider Business Mailing Address Fax Number:
410-219-5132

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27993 CROSS CREEK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21801-2430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-219-5131
Provider Business Practice Location Address Fax Number:
410-219-5132
Provider Enumeration Date:
12/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
EDWARD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-219-5131

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  J1-0000966 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 17674 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 2305205546 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1821045345 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 700290 . This is a "ACN - UNITED HEALTH CARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 5705311 . This is a "FIRST HEALTH / CCN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1821045345 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 311903 . This is a "AMERIGROUP MEDICAID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0530 . This is a "WORKMANS COMP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 700290 . This is a "ACN - UNITED HEALTH CARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 1942207568 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 5705311 . This is a "FIRST HEALTH / CCN" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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