Individual
LISA FIDELIS MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
11201 BENTON ST, LOMA LINDA, CA 92357-1000
(909) 825-7084
Mailing address
11201 BENTON ST, LOMA LINDA, CA 92357-1000
(909) 825-7084
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
AT6523
CA
Other
Enumeration date
09/08/2006
Last updated
07/08/2007
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