Provider Demographics
NPI:1114166964
Name:MARTIN, JASMIN C
Entity Type:Individual
Prefix:
First Name:JASMIN
Middle Name:C
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 NW 92ND TER
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-1700
Mailing Address - Country:US
Mailing Address - Phone:954-415-9027
Mailing Address - Fax:954-341-4910
Practice Address - Street 1:4110 NW 92ND TER
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-1700
Practice Address - Country:US
Practice Address - Phone:954-415-9027
Practice Address - Fax:954-341-4910
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21795225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist