Individual
DR. JUAN MICHELLE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
480 CONGRESS PKWY, LAWRENCEVILLE, GA 30044-4579
(718) 916-1406
Mailing address
480 CONGRESS PKWY, LAWRENCEVILLE, GA 30044-4579
(718) 916-1406
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
009599
GA
2251X0800X
Orthopedic Physical Therapist
029661
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2854827
UNITED HEALTH (UHC)
NY
01
—
712781
MPN
NY
01
—
Q579A1
BCBS
NY
Enumeration date
09/05/2007
Last updated
03/17/2016
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