Provider Demographics
NPI:1730603796
Name:MARTIN, JAMES EDWARD (DPT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8836 TYLER BLVD
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-4361
Mailing Address - Country:US
Mailing Address - Phone:440-255-9553
Mailing Address - Fax:440-255-9563
Practice Address - Street 1:720 ELM ST STE C
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2878
Practice Address - Country:US
Practice Address - Phone:937-283-2186
Practice Address - Fax:937-283-2187
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT017108225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist