Healthcare Provider Details

I. General information

NPI: 1104910785
Provider Name (Legal Business Name): MARTIN THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 ARROYO RIDGE ROAD
ALAMOGORDO NM
88310
US

IV. Provider business mailing address

25 ARROYO RIDGE ROAD
ALAMOGORDO NM
88310
US

V. Phone/Fax

Practice location:
  • Phone: 505-443-8210
  • Fax:
Mailing address:
  • Phone: 505-443-8210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1662
License Number StateNM

VIII. Authorized Official

Name: MRS. SHAWNA ROCHELLE MARTIN
Title or Position: P.T.
Credential: P.T.
Phone: 505-443-8210