Provider Demographics
NPI:1841499787
Name:MARTIN, JOY A
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:A
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7154 W STATE ST # 269
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-7421
Mailing Address - Country:US
Mailing Address - Phone:406-350-0073
Mailing Address - Fax:
Practice Address - Street 1:1905 W APPLEWAY AVE
Practice Address - Street 2:APT. B21
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-8091
Practice Address - Country:US
Practice Address - Phone:406-350-0073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPTA-426225200000X
MT1898225200000X
NMA-0571225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant