Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 2003 |
NPI | 1275099962 |
---|---|
Provider Name | Brittany Martin |
First Address | Citronelle, AL 36522-2605 |
Second Address | Spanish Fort, AL 36527-5456 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2019 |
Last Update Date | 18/02/2019 |