Healthcare Provider Details

I. General information

NPI: 1306114715
Provider Name (Legal Business Name): MARTINE BARRE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARTINE ST.GERMAIN DPT

II. Dates (important events)

Enumeration Date: 12/13/2011
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 SEMINOLE TRL L4
BARBOURSVILLE VA
22923-2836
US

IV. Provider business mailing address

6420 SEMINOLE TRL L4
BARBOURSVILLE VA
22923-2836
US

V. Phone/Fax

Practice location:
  • Phone: 434-939-9524
  • Fax: 434-939-9679
Mailing address:
  • Phone: 434-939-9524
  • Fax: 434-939-9679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6072
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2305208770
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: