Provider Demographics
NPI:1285758870
Name:MARTIN, JOHN RICHARD (PT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:RICHARD
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:JACK
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:32 ARROWHEAD TRL
Mailing Address - Street 2:
Mailing Address - City:OCEAN VIEW
Mailing Address - State:NJ
Mailing Address - Zip Code:08230-1175
Mailing Address - Country:US
Mailing Address - Phone:609-624-3184
Mailing Address - Fax:
Practice Address - Street 1:32 ARROWHEAD TRL
Practice Address - Street 2:
Practice Address - City:OCEAN VIEW
Practice Address - State:NJ
Practice Address - Zip Code:08230-1175
Practice Address - Country:US
Practice Address - Phone:609-624-3184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00299200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist