MEDICARE: MS. ERICA JOY MARTIN PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251P0200X	Pediatric Physical Therapist	024027	NY

General Provider Information

NPI Number	:	1336393792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ERICA JOY MARTIN PT, DPT

Provider Business Mailing Address
First Line	:	204 15TH ST
Second Line	:	APT 1
City	:	BROOKLYN
State	:	NY
Zip	:	11215-4806
Country	:	US
Telephone Number	:	631-786-0502
Fax Number	:

Provider Business Practice Location Address
First Line	:	204 15TH ST
Second Line	:	APT 1
City	:	BROOKLYN
State	:	NY
Zip	:	11215-4806
Country	:	US
Telephone Number	:	631-786-0502
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2008
Last Update Date	:	11/12/2008

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