Individual
MS. STACEY L. MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
1333 SPRING ST., PETOSKEY, MI 49770
(231) 487-4638
(231) 487-4615
Mailing address
P.O. BOX 487, 1333 SPRING ST., PETOSKEY, MI 49770
(231) 487-4638
(231) 487-4615
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
5502000603
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
404773166
—
MI
Enumeration date
09/29/2010
Last updated
09/29/2010
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