Basic Information
| Provider Information | |||||||||
| NPI: | 1952340226 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTINAZZI | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5300 DERRY ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171113576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178392110 | ||||||||
| FaxNumber: | 7175651934 | ||||||||
| Practice Location | |||||||||
| Address1: | 506 MARWALT LN | ||||||||
| Address2: | |||||||||
| City: | ROARING SPRING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166732130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142241370 | ||||||||
| FaxNumber: | 8142241371 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2006 | ||||||||
| LastUpdateDate: | 02/05/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT006537L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 000569770 | 01 | PA | PA BCBS | OTHER | 1011528600001 | 05 | PA | MEDICAID |