Provider Demographics
NPI:1235238148
Name:MARTIN, JENNIFER (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7405 N CEDAR AVE
Mailing Address - Street 2:103
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3838
Mailing Address - Country:US
Mailing Address - Phone:559-261-4100
Mailing Address - Fax:559-261-4101
Practice Address - Street 1:7405 N CEDAR AVE
Practice Address - Street 2:103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3838
Practice Address - Country:US
Practice Address - Phone:559-261-4100
Practice Address - Fax:559-261-4101
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT171682251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00084784OtherMEDICARE RAILROAD IND. #
CADA6172OtherMEDICARE RAILROAD GROUP #
CADA6172OtherMEDICARE RAILROAD GROUP #
CA0PT171680Medicare PIN