Provider Demographics
NPI:1255893202
Name:MARTIN, RICK EDMUND (ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:RICK
Middle Name:EDMUND
Last Name:MARTIN
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:12345 INWOOD RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-8094
Mailing Address - Country:US
Mailing Address - Phone:972-387-8700
Mailing Address - Fax:972-238-1362
Practice Address - Street 1:12345 INWOOD RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-8094
Practice Address - Country:US
Practice Address - Phone:972-387-8700
Practice Address - Fax:972-235-3113
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT12512255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer