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Individual
MARY ELLEN MARTIN
Active
Individual
MARY ELLEN MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070004444
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1619908
BCBS OF IL GROUP NUMBER
IL
01
—
1623066
BCBS OF ILLINOIS
IL
01
—
367885100
US DEPT OF LABOR
IL
Enumeration date
08/30/2006
Last updated
04/14/2015
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