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NPI Code Detail

MEDICARE: MRS. MELISSA DIANE MARTIN PT

MEDICARE: MRS. MELISSA DIANE MARTIN PT
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
1225100000XPhysical Therapist5437-024WI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2859400075OTHERWIMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578565388
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MELISSA DIANE MARTIN PT
Provider Business Mailing Address
First Line : 790 REMINGTON BLVD
Second Line :
City : BOLINGBROOK
State : IL
Zip : 60440-4909
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 315 N MILWAUKEE ST
Second Line :
City : WATERFORD
State : WI
Zip : 53185-4432
Country : US
Telephone Number : 262-514-2700
Fax Number : 262-514-3003
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2005
Last Update Date : 11/21/2024

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Directions to “ MRS. MELISSA DIANE MARTIN PT” Practice Location

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