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Individual

CHARLES C MARTIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PT

Contact information

Practice address
12770 SOUTH FWY, SUITE 144, BURLESON, TX 76028-8447
(817) 426-4401
(817) 426-4410
Mailing address
12770 SOUTH FWY, SUITE 144, BURLESON, TX 76028-8447
(817) 426-4401
(817) 426-4410

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1028421
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
8T4195
BLUE CROSS & BLUE SHIELD
TX
Enumeration date
06/08/2006
Last updated
09/22/2010
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