Martin, Melissa Diane

Martin, Melissa Diane is an individual health care provider with primary practice located at 315 N Milwaukee St , Waterford WI 53185-4432. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as her primary health care specialty. Martin, Melissa Diane can be contacted via phone (262) 514-2700.

Contact Information

Primary practice address
315 N Milwaukee St Waterford WI 53185-4432
Phone: (262) 514-2700
Fax: (262) 514-3003
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 5437-024 Wisconsin

Profile Details

NPI number 1578565388
LBN Legal business name Martin, Melissa Diane
Credentials Physical Therapist (PT)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 11th, 2005
Last updated Mar 1st, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1578565388 NPPES
Wisconsin MEDICAID 40355700
Wisconsin Other 859400075

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