Provider Demographics
NPI:1669646865
Name:MARTIN, DAVID WALKER (LMT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:WALKER
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 1:5615M JACKSON STREET EXT STE 102
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-2274
Mailing Address - Country:US
Mailing Address - Phone:318-442-1100
Mailing Address - Fax:318-442-4020
Practice Address - Street 1:5615M JACKSON STREET EXT STE 102
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-2274
Practice Address - Country:US
Practice Address - Phone:318-442-1100
Practice Address - Fax:318-442-4020
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1854172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist