Healthcare Provider Details

I. General information

NPI: 1861932949
Provider Name (Legal Business Name): DANIEL MARTIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2017
Last Update Date: 03/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 20TH STREET
VERO BEACH FL
32960
US

IV. Provider business mailing address

4025 20TH ST
VERO BEACH FL
32960-2403
US

V. Phone/Fax

Practice location:
  • Phone: 772-569-0444
  • Fax:
Mailing address:
  • Phone: 772-569-0444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235500000X
TaxonomySpeech/Language/Hearing Specialist/Technologist
License NumberAS5231
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: