Provider Demographics
NPI:1386725802
Name:MARTIN, MATTHEW ROBERT (MS, PT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ROBERT
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:520 PHILADELPHIA ST
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3902
Mailing Address - Country:US
Mailing Address - Phone:724-463-7478
Mailing Address - Fax:724-463-0931
Practice Address - Street 1:123 WEST ACADEMY STREET
Practice Address - Street 2:
Practice Address - City:HUGHESVILLE
Practice Address - State:PA
Practice Address - Zip Code:17737
Practice Address - Country:US
Practice Address - Phone:570-584-2772
Practice Address - Fax:570-584-2446
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016656225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7351789OtherAETNA
PA422956OtherHEALTH AMER/HEALTH ASSUR.
PA820290OtherFIRST PRIORITY HEALTH
PA50058134OtherCAPITAL/KHPC
PAMA1824715OtherHIGHMARK BLUE SHIELD
PA820290OtherFIRST PRIORITY HEALTH