Healthcare Provider Details

I. General information

NPI: 1700693850
Provider Name (Legal Business Name): JESSICA MARIE MARTIN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 S I 35 E STE 188
DENTON TX
76205-8154
US

IV. Provider business mailing address

3317 HARDAWAY RD
DENTON TX
76207-7919
US

V. Phone/Fax

Practice location:
  • Phone: 940-222-3800
  • Fax:
Mailing address:
  • Phone: 940-783-3582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2139180
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: