Healthcare Provider Details

I. General information

NPI: 1306588876
Provider Name (Legal Business Name): MARTIS HERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 HARRIS PKWY
FORT WORTH TX
76132-6108
US

IV. Provider business mailing address

6601 HARRIS PKWY
FORT WORTH TX
76132-6108
US

V. Phone/Fax

Practice location:
  • Phone: 817-433-9600
  • Fax:
Mailing address:
  • Phone: 817-433-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number17421
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: