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NPI Code Detail

MEDICARE: JESSICA MARTIN

MEDICARE: JESSICA MARTIN
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
1225200000XPhysical Therapy Assistant801255205MS

General Provider Information

NPI Number : 1912204009
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA MARTIN
Provider Business Mailing Address
First Line : 4109 HIGHWAY 98 W
Second Line :
City : SUMMIT
State : MS
Zip : 39666-9132
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 217 METHODIST BLVD
Second Line :
City : HATTIESBURG
State : MS
Zip : 39402-1338
Country : US
Telephone Number : 601-329-2233
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/25/2011
Last Update Date : 02/25/2011

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Directions to “ JESSICA MARTIN ” Practice Location

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