Provider Demographics
NPI:1164887931
Name:MARTIN, BETH
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
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 1:2034 DABNEY RD STE C
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3361
Mailing Address - Country:US
Mailing Address - Phone:804-649-9043
Mailing Address - Fax:804-783-8212
Practice Address - Street 1:2034 DABNEY RD STE C
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3361
Practice Address - Country:US
Practice Address - Phone:804-649-9043
Practice Address - Fax:804-783-8212
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILCO04662222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist