Healthcare Provider Details

I. General information

NPI: 1154141968
Provider Name (Legal Business Name): DEANA MARTIN ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W 5TH ST
EAST LIVERPOOL OH
43920-2405
US

IV. Provider business mailing address

839 BUENA VISTA BLVD
STEUBENVILLE OH
43952-1026
US

V. Phone/Fax

Practice location:
  • Phone: 330-385-7200
  • Fax:
Mailing address:
  • Phone: 740-346-8282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberAT003284
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: