Provider Demographics
NPI:1992055651
Name:MARTIN, CHRISTOPHER PETER
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:PETER
Last Name:MARTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 NEW HAVEN AVE
Mailing Address - Street 2:117
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-6965
Mailing Address - Country:US
Mailing Address - Phone:203-671-4871
Mailing Address - Fax:
Practice Address - Street 1:67 GRANT STREET
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06601
Practice Address - Country:US
Practice Address - Phone:203-384-3715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1183225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant