Provider Demographics
NPI:1366639825
Name:SALOMON, MARTIN (PT)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:SALOMON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 HOLLY LN NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-3514
Mailing Address - Country:US
Mailing Address - Phone:347-243-6403
Mailing Address - Fax:
Practice Address - Street 1:1302 HOLLY LN NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-3514
Practice Address - Country:US
Practice Address - Phone:347-243-6403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029641-1225100000X
GAPT010772225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ3R12Q4AC1Medicare PIN