Individual
MR. MICHEAL SHAWN MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MPT,ATC,CSCS,PES
Contact information
Practice address
3900 N PARKVIEW DR, FAYETTEVILLE, AR 72703-6398
(479) 966-4187
(479) 967-9658
Mailing address
4600 W TUPELO WAY, FAYETTEVILLE, AR 72704-6478
(479) 200-1121
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2890
AR
2255A2300X
Athletic Trainer
234
AR
Other
Enumeration date
01/16/2007
Last updated
01/24/2014
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