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General NPI Number Information
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NPI Number | 1386976710
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Entity Type | Individual
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Provider Name | THERESA ANN MARTIN DC
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Gender | Female
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Dates
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Enumeration Date | 02/10/2010
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Last Update Date | 03/28/2012
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Provider Practice Location Address
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Address Line | 1180 PONCE DELEON BLVD 601B
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City | CLEARWATER
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State | FL
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Zip | 33756-1031
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Country | US
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Telephone | 727-400-4807
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Fax | 727-400-4809
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Provider Business Mailing Address
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Address Line | 1180 PONCE DELEON BLVD 601B
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City | CLEARWATER
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State | FL
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Zip | 33756-1031
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Country | US
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Telephone | 727-400-4807
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Fax | 727-400-4809
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH9721
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC31944
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License Number State | CA
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