Healthcare Provider Details

I. General information

NPI: 1033464045
Provider Name (Legal Business Name): LAUREN ANN MARTIN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAUREN JOHNSON

II. Dates (important events)

Enumeration Date: 07/16/2012
Last Update Date: 03/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 DAIRY LN
ELIZABETHTOWN PA
17022-9547
US

IV. Provider business mailing address

7 DOCK HILL RD
MIDDLEBURG PA
17842-8910
US

V. Phone/Fax

Practice location:
  • Phone: 717-560-2917
  • Fax: 717-560-2985
Mailing address:
  • Phone: 570-837-2123
  • Fax: 570-837-2185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberDAPT003111
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT022142
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: