Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PTH3377 | AL |
N | 2251S0007X | Physical Therapist - Sports | PTH3377 | AL |
N | 2251X0800X | Physical Therapist - Orthopedic | PTH3377 | AL |
NPI | 1245260942 |
---|---|
Provider Name | Roxanne Rene St. Martin |
First Address | Morris, AL 35116-1969 |
Second Address | Morris, AL 35116-1969 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 27/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1063009918 | NPI 2- RSM2PT (01) | |
1245260942 | NPI 1- INDIVIDUAL (01) |