Individual
BECKY JOANN MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
100 SAN CARLOS RD APT 310, PUEBLO, CO 81005-2665
(719) 564-2370
Mailing address
100 SAN CARLOS RD APT 310, PUEBLO, CO 81005-2665
(719) 564-2370
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
311679605
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0012683
COLORADO PTA-C
CO
Enumeration date
04/12/2011
Last updated
05/20/2015
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