Individual
VAN MARTIN III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5865 CAPO ISLAND RD, SAINT AUGUSTINE, FL 32095-9624
(904) 325-3315
Mailing address
5865 CAPO ISLAND RD, SAINT AUGUSTINE, FL 32095-9624
(904) 325-3315
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
05/31/2016
Last updated
05/31/2016
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