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General NPI Number Information
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NPI Number | 1609664804
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Entity Type | Individual
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Provider Name | TEDDY JOE MARTIN II LMT
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Gender | Male
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Dates
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Enumeration Date | 04/28/2025
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 3857 TEAYS VALLEY RD
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City | HURRICANE
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State | WV
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Zip | 25526-0328
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Country | US
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Telephone | 304-519-9270
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Fax | 304-519-9271
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Provider Business Mailing Address
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Address Line | 2305 JEFFERSON AVE
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City | SAINT ALBANS
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State | WV
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Zip | 25177-3205
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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 | 2013-3120
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License Number State | WV
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