Basic Information
| Provider Information | |||||||||
| NPI: | 1386725802 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | ROBERT | ||||||||
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| Credential: | MS, PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 520 PHILADELPHIA ST | ||||||||
| Address2: | |||||||||
| City: | INDIANA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 157013902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7244637478 | ||||||||
| FaxNumber: | 7244630931 | ||||||||
| Practice Location | |||||||||
| Address1: | 123 WEST ACADEMY STREET | ||||||||
| Address2: | |||||||||
| City: | HUGHESVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5705842772 | ||||||||
| FaxNumber: | 5705842446 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT016656 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 7351789 | 01 | PA | AETNA | OTHER | 422956 | 01 | PA | HEALTH AMER/HEALTH ASSUR. | OTHER | 820290 | 01 | PA | FIRST PRIORITY HEALTH | OTHER | 50058134 | 01 | PA | CAPITAL/KHPC | OTHER | MA1824715 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER |