Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | PT017726 | OH |
NPI | 1265998017 |
---|---|
Provider Name | Jeremy D Martin |
First Address | Cincinnati, OH 45247-7961 |
Second Address | Cincinnati, OH 45241-2374 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2019 |
Last Update Date | 18/02/2019 |