Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 723 | MT |
N | 2251E1200X | Ergonomics | 723 | MT |
N | 225XE1200X | Ergonomics | 723 | MT |
NPI | 1285848507 |
---|---|
Provider Name | Ms. Traci Lynn Martin |
First Address | Great Falls, MT 59405-5161 |
Second Address | Great Falls, MT 59405-4324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 29/01/2020 |