Provider Demographics
NPI:1639103450
Name:MARTIN, COLIN (PT)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 TWIN PINES CIR
Mailing Address - Street 2:
Mailing Address - City:TUSCUMBIA
Mailing Address - State:AL
Mailing Address - Zip Code:35674-7704
Mailing Address - Country:US
Mailing Address - Phone:256-332-1871
Mailing Address - Fax:256-350-7757
Practice Address - Street 1:14001 HIGHWAY 43
Practice Address - Street 2:FRANKLIN PLAZA SUITE 18 & 19
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-2848
Practice Address - Country:US
Practice Address - Phone:256-331-0070
Practice Address - Fax:256-331-0054
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH2329174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist