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General NPI Number Information
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NPI Number | 1376497784
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Entity Type | Individual
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Provider Name | TEDRIA L MARTIN LMT, NT
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Gender | Female
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Dates
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Enumeration Date | 02/23/2026
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Last Update Date | 02/23/2026
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Provider Practice Location Address
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Address Line | 2013 N ASHLEY ST
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City | VALDOSTA
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State | GA
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Zip | 31602-3028
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Country | US
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Telephone | 229-234-9118
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10351
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City | VALDOSTA
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State | GA
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Zip | 31604-0351
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Country | US
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Telephone |
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Fax |
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT015492
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License Number State | GA
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