Organization
MARTIN VENTURES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHANCE MARTIN (OWNER)
(417) 402-0302
Entity
Organization
Contact information
Practice address
3119 S SCENIC AVE STE B, SPRINGFIELD, MO 65807-3965
(417) 402-0302
Mailing address
4811 W STANFORD ST, SPRINGFIELD, MO 65802-7773
(417) 402-0302
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2014019578
PHYSICAL THERAPY LICENSE NUMBER
MO
Enumeration date
06/21/2020
Last updated
06/21/2020
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