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Individual

NICHOLAS J. MARTIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LPT, PT

Contact information

Practice address
1425 MAIN ST, FOLLANSBEE, WV 26037-1217
(304) 527-4472
(304) 527-4648
Mailing address
414 PENCO RD, WEIRTON, WV 26062
(304) 723-3780
(304) 723-4110

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
001084
WV
225100000X
Physical Therapist
PT006744L
PA
225100000X
Physical Therapist
PT007091
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000745333
BLUE CROSS/BLUE SHIELD
05
0156604000
WV
01
1515473000
US DEPT OF LABOR
WV
01
55071930000
WV WORKERS COMP BRICKSTEE
WV
01
55071930003
THE HEALTH PLAN BWC
WV
Enumeration date
08/11/2006
Last updated
04/01/2024
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