Individual
JACQULYN LORAINE MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1400 HILLTOP RD, KERRVILLE, TX 78028-2851
(830) 895-3200
(830) 895-3865
Mailing address
37 TWO PINES LN, FREDERICKSBURG, TX 78624-5861
(830) 998-9972
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2008652
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2008652
PROFESSIONAL LICENSE
TX
Enumeration date
08/30/2018
Last updated
08/30/2018
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