Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 034114-1 | NY |
NPI | 1093230229 |
---|---|
Provider Name | Rebecca Ann Martin |
First Address | North Lawrence, NY 12967-9788 |
Second Address | Potsdam, NY 13676-1889 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2017 |
Last Update Date | 09/08/2017 |