Provider Demographics
NPI:1487983474
Name:MARTINO, DONNA (PT)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:MARTINO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1757 MERRICK AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:N MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-2717
Mailing Address - Country:US
Mailing Address - Phone:516-623-4388
Mailing Address - Fax:516-623-1948
Practice Address - Street 1:1757 MERRICK AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:N MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-2717
Practice Address - Country:US
Practice Address - Phone:516-623-4388
Practice Address - Fax:516-623-1948
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY013821-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist