Provider Demographics
NPI:1306295696
Name:THEIRL, MARTHA A (PT, DPT)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:A
Last Name:THEIRL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:A
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:654 BEACON ST STE 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-2099
Mailing Address - Country:US
Mailing Address - Phone:617-536-1161
Mailing Address - Fax:
Practice Address - Street 1:654 BEACON ST STE 2
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-2099
Practice Address - Country:US
Practice Address - Phone:617-536-1161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291092225100000X
MA22934225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty