MEDICARE: MR. MARK CHRISTOPHER MARTIRE 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
1	225100000X	Physical Therapist	008606	CT
2	225100000X	Physical Therapist	10502	SC
3	2255A2300X	Athletic Trainer	000154	CT

General Provider Information

NPI Number	:	1952432916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK CHRISTOPHER MARTIRE PT

Provider Business Mailing Address
First Line	:	235 NICHOLS AVE
Second Line	:
City	:	SHELTON
State	:	CT
Zip	:	06484-5845
Country	:	US
Telephone Number	:	203-929-5019
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 IVY BROOK RD
Second Line	:
City	:	SHELTON
State	:	CT
Zip	:	06484-6416
Country	:	US
Telephone Number	:	203-924-2853
Fax Number	:

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

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	09/11/2025

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