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General NPI Number Information
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NPI Number | 1477614741
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Entity Type | Organization
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Legal Business Name | LEMUEL C & ELMEZEN MARTIN
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 07/16/2015
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Provider Practice Location Address
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Address Line | 422 LAKEPORT BLVD
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City | LAKEPORT
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State | CA
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Zip | 95453-5404
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Country | US
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Telephone | 707-263-6845
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Fax | 707-263-6451
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Provider Business Mailing Address
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Address Line | PO BOX 1560
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City | LAKEPORT
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State | CA
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Zip | 95453-1560
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Country | US
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Telephone | 707-263-6845
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Fax | 707-263-6451
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Authorized Official
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Title or Position | PHYSICAL THERAPIST OWNER
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Name | MR. LEMUEL CAMPOMANES MARTIN
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Credential | PT
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Telephone | 707-263-6845
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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 | PT11399
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License Number State | CA
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