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General NPI Number Information
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NPI Number | 1700693850
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Entity Type | Individual
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Provider Name | JESSICA MARIE MARTIN PTA
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Gender | Female
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Dates
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Enumeration Date | 12/12/2024
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 725 S I 35 E STE 188
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City | DENTON
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State | TX
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Zip | 76205-8154
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Country | US
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Telephone | 940-222-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 3317 HARDAWAY RD
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City | DENTON
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State | TX
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Zip | 76207-7919
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Country | US
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Telephone | 940-783-3582
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2139180
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License Number State | TX
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