Healthcare Provider Details

I. General information

NPI: 1326968744
Provider Name (Legal Business Name): JUAN MARTIN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 W POPLAR AVE
COLLIERVILLE TN
38017-0605
US

IV. Provider business mailing address

1900 W POPLAR AVE
COLLIERVILLE TN
38017-0605
US

V. Phone/Fax

Practice location:
  • Phone: 901-759-3111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: