Provider Demographics
NPI:1144410895
Name:WAYNE MARTIN, INC.
Entity Type:Organization
Organization Name:WAYNE MARTIN, INC.
Other - Org Name:MASSAGE MATTERS OF TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LMT, CNMT, LDT
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:432-638-4643
Mailing Address - Street 1:3103 BARKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-6215
Mailing Address - Country:US
Mailing Address - Phone:432-638-4643
Mailing Address - Fax:432-694-6412
Practice Address - Street 1:2301 W WALL ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6348
Practice Address - Country:US
Practice Address - Phone:432-638-4643
Practice Address - Fax:432-694-6412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT028169305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service