Provider Demographics
NPI:1144892944
Name:PROKOP, MARTIN THEODORE (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:THEODORE
Last Name:PROKOP
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:313 OLD RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HOLLSOPPLE
Mailing Address - State:PA
Mailing Address - Zip Code:15935-8515
Mailing Address - Country:US
Mailing Address - Phone:724-636-0408
Mailing Address - Fax:
Practice Address - Street 1:210 INDUSTRIAL PARK RD STE 140
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-1948
Practice Address - Country:US
Practice Address - Phone:814-534-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist