MEDICARE: JAMAEA MARTIN LPTA

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	225200000X	Physical Therapy Assistant	5502004729	MI
2	225700000X	Massage Therapist	7501016542	MI

General Provider Information

NPI Number	:	1598212219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMAEA MARTIN LPTA

Provider Business Mailing Address
First Line	:	2414 DENTON RD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-3719
Country	:	US
Telephone Number	:	517-240-9579
Fax Number	:

Provider Business Practice Location Address
First Line	:	232 W PROSPECT ST STE 103
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-4168
Country	:	US
Telephone Number	:	517-240-9579
Fax Number	:

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

Provider Enumeration Date	:	09/10/2016
Last Update Date	:	01/19/2026

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Directions to “ JAMAEA MARTIN LPTA” Practice Location

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