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Individual

SHELBY MARTIN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
ATC

Contact information

Practice address
5750 CHRISTMAS LAKE RD, EXCELSIOR, MN 55331-3303
(952) 412-1411
Mailing address
5750 CHRISTMAS LAKE RD, EXCELSIOR, MN 55331-3303
(952) 412-1411

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
FXF656A22785
ANTHEM BLUE CROSS
MN
Enumeration date
01/17/2017
Last updated
04/27/2017
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