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General NPI Number Information
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NPI Number | 1841499787
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Entity Type | Individual
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Provider Name | JOY A MARTIN
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Gender | Female
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Dates
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Enumeration Date | 07/11/2007
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Last Update Date | 07/11/2007
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Provider Practice Location Address
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Address Line | 1905 W APPLEWAY AVE APT. B21
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City | COEUR D ALENE
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State | ID
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Zip | 83814-8091
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Country | US
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Telephone | 406-350-0073
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Fax |
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Provider Business Mailing Address
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Address Line | 7154 W STATE ST # 269
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City | BOISE
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State | ID
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Zip | 83714-7421
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Country | US
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Telephone | 406-350-0073
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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 | PTA-426
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 1898
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License Number State | MT
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Taxonomy #3
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A-0571
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License Number State | NM
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