Provider Demographics
NPI:1467656934
Name:MARTIN, JOSHUA SMITH (LMT PTA)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:SMITH
Last Name:MARTIN
Suffix:
Gender:M
Credentials:LMT PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7409 OXFORD GARDEN CIR
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-1729
Mailing Address - Country:US
Mailing Address - Phone:813-377-9925
Mailing Address - Fax:
Practice Address - Street 1:7409 OXFORD GARDEN CIR
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-1729
Practice Address - Country:US
Practice Address - Phone:813-377-9925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA42397225700000X
FLPTA22744225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist