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General NPI Number Information
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NPI Number | 1689657124
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Entity Type | Individual
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Provider Name | JUSTIN LOUIS MARTIN PT
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Gender | Male
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Dates
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Enumeration Date | 11/29/2005
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 4500 8TH DIVISION RD
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City | COLUMBIA
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State | SC
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Zip | 29207-5700
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Country | US
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Telephone | 37-512-4088
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Fax |
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Provider Business Mailing Address
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Address Line | 2513 BURNEY DR
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City | COLUMBIA
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State | SC
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Zip | 29205-3116
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Country | US
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Telephone | 623-326-9872
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT006472
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License Number State | GA
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