Provider Demographics
NPI:1114032018
Name:MARTIN, JACOB LEE (MPT)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:LEE
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MPT
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Mailing Address - Street 1:4700 SETON CENTER PKWY
Mailing Address - Street 2:STE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4107
Mailing Address - Country:US
Mailing Address - Phone:512-439-1000
Mailing Address - Fax:512-439-1081
Practice Address - Street 1:4700 SETON CENTER PKWY
Practice Address - Street 2:STE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4107
Practice Address - Country:US
Practice Address - Phone:512-439-1000
Practice Address - Fax:512-439-1081
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2019-11-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX1161218225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX742862345OtherGOLDEN RULE
TX772862345OtherGREAT WEST
TX742862345OtherSCOTT & WHITE
TX2274981OtherFIRST HEALTH
TX742862345OtherHEALTHSMART
TX742862345OtherGALAXY
TX742862345OtherPHCS
TX742862345OtherTRUE CHOICE
TX742862345OtherHUMANA
TX742862345OtherUNICARE
TX8T4542/0092EXOtherBCBS
TX742862345OtherCIGNA
TX742862345OtherGALAXY