Provider Demographics
NPI:1194205575
Name:MARTIN, JOYCE REEDER
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:REEDER
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 1:5131 WEAVER BEND RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:75949-6133
Mailing Address - Country:US
Mailing Address - Phone:936-422-9737
Mailing Address - Fax:
Practice Address - Street 1:201 S JOHN REDDITT DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3142
Practice Address - Country:US
Practice Address - Phone:936-632-8223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2040046225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2040046OtherPHYSICAL THERAPIST ASSISTANT - REGULAR LICENSE