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General NPI Number Information
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NPI Number | 1245467562
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Entity Type | Individual
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Provider Name | MARIA N MARTIN P.T.
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Gender | Female
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Dates
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Enumeration Date | 06/12/2009
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Last Update Date | 06/12/2009
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Provider Practice Location Address
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Address Line | 501 S AUSTIN AVE #1310
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City | GEORGETOWN
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State | TX
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Zip | 78626-5610
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Country | US
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Telephone | 512-864-6054
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Fax | 512-869-8157
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Provider Business Mailing Address
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Address Line | 501 S AUSTIN AVE #1310
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City | GEORGETOWN
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State | TX
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Zip | 78626-5610
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Country | US
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Telephone | 512-864-6054
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Fax | 512-869-8157
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1073518
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License Number State | TX
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