Provider Demographics
NPI:1538305040
Name:MARTIN, TROY JOHN (LMT)
Entity Type:Individual
Prefix:MR
First Name:TROY
Middle Name:JOHN
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 1:1875 HACKBERRY DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1236
Mailing Address - Country:US
Mailing Address - Phone:928-273-8417
Mailing Address - Fax:928-445-0715
Practice Address - Street 1:1875 HACKBERRY DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1236
Practice Address - Country:US
Practice Address - Phone:928-273-8417
Practice Address - Fax:928-445-0715
Is Sole Proprietor?:No
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-11913225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist