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General NPI Number Information
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NPI Number | 1073771622
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Entity Type | Individual
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Provider Name | DAVID MARTIN PT
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Gender | Male
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Dates
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Enumeration Date | 05/30/2008
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Last Update Date | 05/30/2013
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Provider Practice Location Address
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Address Line | 1500 VESTAL PKWY E
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City | VESTAL
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State | NY
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Zip | 13850-1830
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Country | US
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Telephone | 607-240-9120
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Fax |
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Provider Business Mailing Address
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Address Line | 1012 LITTLE MEADOWS RD
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City | WARREN CENTER
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State | PA
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Zip | 18851-7726
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Country | US
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Telephone | 570-395-0190
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT019277
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 62034406
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License Number State | NY
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