Provider Demographics
NPI:1053454686
Name:MARTIN, AUDREY DENISE (ATC, LAT, RMT)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:DENISE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:ATC, LAT, RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7704 WATER FOWL TRL
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-4571
Mailing Address - Country:US
Mailing Address - Phone:817-473-4799
Mailing Address - Fax:
Practice Address - Street 1:7704 WATER FOWL TRL
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-4571
Practice Address - Country:US
Practice Address - Phone:817-473-4799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23182255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer