Martin Pediatric Physical Therapy, Inc.

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

070.013168 Issued in IL

Legal business name

MARTIN PEDIATRIC PHYSICAL THERAPY, INC.

Practice address

656 Blazing Star Dr
Lake Villa, IL 60046-9012

Phone

(847) 863-3901

Fax

(847) 245-1476

NPI assigned

Sep 21, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Joy S Martin, DPT, ATCNPI 1689695348

Title

Owner

Phone

(847) 863-3901

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Joy Suzann Martin, DPT

  • Physical Therapist
  • Lake Villa, IL
  • NPI 1689695348
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333929600000",
    "number": "1952597098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "656 BLAZING STAR DR",
            "city": "LAKE VILLA",
            "state": "IL",
            "postal_code": "600469012",
            "telephone_number": "847-863-3901",
            "fax_number": "847-245-1476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "656 BLAZING STAR DR",
            "city": "LAKE VILLA",
            "state": "IL",
            "postal_code": "600469012",
            "telephone_number": "847-863-3901",
            "fax_number": "847-245-1476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTIN PEDIATRIC PHYSICAL THERAPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-21",
        "last_updated": "2012-04-09",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "JOY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-863-3901",
        "authorized_official_credential": "DPT, ATC"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "IL",
            "license": "070.013168",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Leigh Lipinski, LSW
• George Winston Lutz, PH.D.
• Anita Johanson Maddox, LCPC
• Susan R Magee, LCPC, CADC
• Magnolia Wellness Center
• Joy Suzann Martin, DPT
• Viktoriia V Martin, LPC
• Semyon Maslovsky, MD
• Gabrielle Mazade, APRN, CNP
• Ashley J McDowell, SLP

• Home Health Agency in Lake Villa, IL
• Providers in Lake Villa, IL by specialty
• Home Health Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.