Individual
DIANE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
4320 HOLLY TREE PL, FORT WAYNE, IN 46804-4815
(260) 432-8173
Mailing address
4320 HOLLY TREE PL, FORT WAYNE, IN 46804-4815
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05001067A
IN
Other
Enumeration date
07/09/2006
Last updated
01/11/2011
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