MEDICARE: MS. JODY ROCHELLE MARTIN MSPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT 23976	FL
2	225100000X	Physical Therapist	6402	AZ
3	225100000X	Physical Therapist	30329	CA
4	225100000X	Physical Therapist	025997-1	NY

General Provider Information

NPI Number	:	1063723583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JODY ROCHELLE MARTIN MSPT

Provider Business Mailing Address
First Line	:	1867 SW JAMESPORT DR
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34953-4599
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1867 SW JAMESPORT DR
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34953-4599
Country	:	US
Telephone Number	:	917-892-5187
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2010
Last Update Date	:	06/30/2010

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