Healthcare Provider Details

I. General information

NPI: 1386353316
Provider Name (Legal Business Name): SIERRA MARTIN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2022
Last Update Date: 11/17/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 S COLLEGE AVE STE 160
NEWARK DE
19713-1302
US

IV. Provider business mailing address

1441 WILLIAM ST
BALTIMORE MD
21230-4544
US

V. Phone/Fax

Practice location:
  • Phone: 302-831-8893
  • Fax:
Mailing address:
  • Phone: 970-456-3731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0014500
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: