Healthcare Provider Details

I. General information

NPI: 1245260942
Provider Name (Legal Business Name): ROXANNE RENE ST. MARTIN PT, DPT, SCS, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 01/27/2021
Certification Date: 12/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 SEDGEFIELD CIR
MORRIS AL
35116-1969
US

IV. Provider business mailing address

1081 SEDGEFIELD CIR
MORRIS AL
35116-1969
US

V. Phone/Fax

Practice location:
  • Phone: 334-233-3651
  • Fax:
Mailing address:
  • Phone: 334-233-3651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPTH3377
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPTH3377
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number704
License Number StateAL
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH3377
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: