Provider Demographics
NPI:1245260942
Name:ST. MARTIN, ROXANNE RENE (PT, DPT, SCS, ATC)
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:RENE
Last Name:ST. MARTIN
Suffix:
Gender:F
Credentials:PT, DPT, SCS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1081 SEDGEFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:AL
Mailing Address - Zip Code:35116-1969
Mailing Address - Country:US
Mailing Address - Phone:334-233-3651
Mailing Address - Fax:
Practice Address - Street 1:1081 SEDGEFIELD CIR
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:AL
Practice Address - Zip Code:35116-1969
Practice Address - Country:US
Practice Address - Phone:334-233-3651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH33772251S0007X, 2251X0800X, 225100000X
AL7042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
1063009918OtherNPI 2- RSM2PT
1245260942OtherNPI 1- INDIVIDUAL