Provider Demographics
NPI:1528724374
Name:THOMAS, MARTINA ELIZABETH (PT, DPT)
Entity type:Individual
Prefix:
First Name:MARTINA
Middle Name:ELIZABETH
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 RENAISSANCE DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-6331
Mailing Address - Country:US
Mailing Address - Phone:856-834-6168
Mailing Address - Fax:
Practice Address - Street 1:701 RENAISSANCE DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-6331
Practice Address - Country:US
Practice Address - Phone:856-834-6168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300097225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA300097OtherPT LICENSE CALIFORNIA