MEDICARE: MICHELLE MARTIN PHYSICAL THERAPIST

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	225100000X	Physical Therapist	3062	IN

General Provider Information

NPI Number	:	1831282136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE MARTIN PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	10995 ALLISONVILLE RD
Second Line	:	SUITE 101
City	:	FISHERS
State	:	IN
Zip	:	46038-2616
Country	:	US
Telephone Number	:	317-845-9628
Fax Number	:	317-845-9740

Provider Business Practice Location Address
First Line	:	10995 ALLISONVILLE RD
Second Line	:	SUITE 101
City	:	FISHERS
State	:	IN
Zip	:	46038-2616
Country	:	US
Telephone Number	:	317-845-9628
Fax Number	:	317-845-9740

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/08/2007

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