Provider Demographics
NPI:1396968780
Name:MARTIN, EMILY ANNE (DPT)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:ANNE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:EMILY
Other - Middle Name:ANNE
Other - Last Name:MERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7057 DEXTER ANN ARBOR RD
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130-8568
Practice Address - Country:US
Practice Address - Phone:734-426-3768
Practice Address - Fax:734-426-1406
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013285225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI6211083Medicare PIN