Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 05000805A | IN |
N | 2251C2600X | Cardiopulmonary | 05000805A | IN |
N | 2251E1200X | Ergonomics | 05000805A | IN |
N | 225XE1200X | Ergonomics | 05000805A | IN |
N | 2251E1300X | Electrophysiology, Clinical | 05000805A | IN |
N | 2251G0304X | Physical Therapist - Geriatrics | 05000805A | IN |
N | 2251H1200X | Hand | 05000805A | IN |
N | 2251H1300X | Human Factors | 05000805A | IN |
N | 225XH1300X | Human Factors | 05000805A | IN |
N | 2251N0400X | Physical Therapist - Neurology | 05000805A | IN |
N | 2251P0200X | Physical Therapist - Pediatrics | 05000805A | IN |
N | 2251S0007X | Physical Therapist - Sports | 05000805A | IN |
N | 2251X0800X | Physical Therapist - Orthopedic | 05000805A | IN |
NPI | 1598962631 |
---|---|
Provider Name | Suzanne C Martin |
First Address | Evansville, IN 47714-0137 |
Second Address | Evansville, IN 47714-0137 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000218670 | ANTHEM BC & BS PIN (01) | IN |