Provider Demographics
NPI:1023134954
Name:SWEENEY-MARTIN, FERN A (LPTA)
Entity type:Individual
Prefix:MRS
First Name:FERN
Middle Name:A
Last Name:SWEENEY-MARTIN
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37094
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-0094
Mailing Address - Country:US
Mailing Address - Phone:216-970-9418
Mailing Address - Fax:216-901-0401
Practice Address - Street 1:20265 EMERY RD
Practice Address - Street 2:
Practice Address - City:NORTH RANDALL
Practice Address - State:OH
Practice Address - Zip Code:44128-4122
Practice Address - Country:US
Practice Address - Phone:216-475-8880
Practice Address - Fax:216-587-4806
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00435225200000X
TX2073007225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant