Healthcare Provider Details

I. General information

NPI: 1073026589
Provider Name (Legal Business Name): RAITHEL JEAN MARTIN MSE, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2017
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 NW 3RD ST
ANDREWS TX
79714-5014
US

IV. Provider business mailing address

6610 N LOVINGTON HWY
HOBBS NM
88240-9120
US

V. Phone/Fax

Practice location:
  • Phone: 432-523-3640
  • Fax:
Mailing address:
  • Phone: 210-213-0147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT7439
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: