Provider Demographics
NPI:1942439252
Name:MARTIN, WILLIAM H (PT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:H
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 1:65 DUTCH LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39702-5523
Mailing Address - Country:US
Mailing Address - Phone:662-241-4545
Mailing Address - Fax:662-241-4025
Practice Address - Street 1:513 ACADEMY RD
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-4021
Practice Address - Country:US
Practice Address - Phone:662-268-8013
Practice Address - Fax:662-268-8095
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT4501225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist