MEDICARE: DAREN LAVEL MARTIN MPT

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
1	225100000X	Physical Therapist	995	WY

General Provider Information

NPI Number	:	1750593703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAREN LAVEL MARTIN MPT

Provider Business Mailing Address
First Line	:	1977 DEWAR DR
Second Line	:	STE J
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-5757
Country	:	US
Telephone Number	:	307-382-3228
Fax Number	:

Provider Business Practice Location Address
First Line	:	1977 DEWAR DR
Second Line	:	STE. J
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-5737
Country	:	US
Telephone Number	:	307-382-3228
Fax Number	:	307-382-6886

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	08/02/2018

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