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General NPI Number Information
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NPI Number | 1104910785
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Entity Type | Organization
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Legal Business Name | MARTIN THERAPY
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 25 ARROYO RIDGE ROAD
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City | ALAMOGORDO
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State | NM
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Zip | 88310
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Country | US
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Telephone | 505-443-8210
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Fax |
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Provider Business Mailing Address
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Address Line | 25 ARROYO RIDGE ROAD
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City | ALAMOGORDO
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State | NM
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Zip | 88310
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Country | US
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Telephone | 505-443-8210
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Fax |
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Authorized Official
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Title or Position | P.T.
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Name | MRS. SHAWNA ROCHELLE MARTIN
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Credential | P.T.
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Telephone | 505-443-8210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1662
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License Number State | NM
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