Healthcare Provider Details

I. General information

NPI: 1275838997
Provider Name (Legal Business Name): ERIN M MARTIN LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2011
Last Update Date: 01/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 N STATE ST
JACKSON MS
39202-2413
US

IV. Provider business mailing address

PO BOX 23090
JACKSON MS
39225-3090
US

V. Phone/Fax

Practice location:
  • Phone: 601-968-1148
  • Fax: 601-968-1337
Mailing address:
  • Phone: 601-968-1148
  • Fax: 601-968-1337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA2481
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: