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General NPI Number Information
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NPI Number | 1548142953
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Entity Type | Individual
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Provider Name | JESSICA MARTIN PTA
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Gender | Female
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Dates
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Enumeration Date | 07/24/2025
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 115 ALMOND DR
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City | ARAB
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State | AL
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Zip | 35016-3749
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Country | US
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Telephone | 256-302-6315
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Fax |
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Provider Business Mailing Address
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Address Line | 155 LECROY RD
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City | GUNTERSVILLE
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State | AL
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Zip | 35976-7749
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Country | US
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Telephone | 256-302-6315
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Fax | 256-302-6315
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA5177
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License Number State | AL
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