Provider Demographics
NPI:1467091439
Name:MARTIN, JAMES PATRICK (LMT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:PATRICK
Last Name:MARTIN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 409
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AR
Mailing Address - Zip Code:72641-0409
Mailing Address - Country:US
Mailing Address - Phone:479-619-9802
Mailing Address - Fax:
Practice Address - Street 1:100 WEST SOUTH STREET
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AR
Practice Address - Zip Code:72641
Practice Address - Country:US
Practice Address - Phone:479-619-9802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7903225700000X, 173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173C00000XOther Service ProvidersReflexologistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty