Healthcare Provider Details

I. General information

NPI: 1811969462
Provider Name (Legal Business Name): SEAN MARTIN EDIN ATC, PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8295 N 7TH ST
FRESNO CA
93720-2208
US

IV. Provider business mailing address

8295 N 7TH ST
FRESNO CA
93720-2208
US

V. Phone/Fax

Practice location:
  • Phone: 559-217-7189
  • Fax:
Mailing address:
  • Phone: 559-217-7189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberAT 3717
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: