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NPI Code Detail

MEDICARE: MR. DARRYL LYNN MARTIN P.T.

MEDICARE: MR. DARRYL LYNN MARTIN P.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist1116481TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10022JNOTHERTXBLUE CROSS/BLUE SHIELD
28T0497OTHERTXBLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number : 1164417002
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DARRYL LYNN MARTIN P.T.
Provider Business Mailing Address
First Line : 1301 E HOUSTON ST
Second Line :
City : BEEVILLE
State : TX
Zip : 78102-5309
Country : US
Telephone Number : 361-362-1700
Fax Number : 361-362-1369
Provider Business Practice Location Address
First Line : 1301 E HOUSTON ST
Second Line :
City : BEEVILLE
State : TX
Zip : 78102-5309
Country : US
Telephone Number : 361-362-1700
Fax Number : 361-362-1369
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2005
Last Update Date : 01/23/2008

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