Healthcare Provider Details

I. General information

NPI: 1821045345
Provider Name (Legal Business Name): MARTIN PHYSICAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2006
Last Update Date: 04/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N WASHINGTON ST
SNOW HILL MD
21863-1054
US

IV. Provider business mailing address

200 N WASHINGTON ST
SNOW HILL MD
21863-1054
US

V. Phone/Fax

Practice location:
  • Phone: 443-234-5074
  • Fax: 443-234-5087
Mailing address:
  • Phone: 443-234-5074
  • Fax: 443-234-5087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number17674
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0000966
License Number StateDE
# 4
Primary TaxonomyN
Taxonomy Code2251E1200X
TaxonomyErgonomics Physical Therapist
License Number17674
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code2251E1200X
TaxonomyErgonomics Physical Therapist
License NumberJ1-0000966
License Number StateDE
# 6
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number17674
License Number StateMD
# 7
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberJ1-0000966
License Number StateDE

VIII. Authorized Official

Name: MR. STEPHEN EDWARD MARTIN
Title or Position: PRESIDENT
Credential: P.T., OCS
Phone: 443-234-5074