Individual
JARED TRAVIS MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
625 E BROADWAY AVE, JACKSON, WY 83001-8642
(307) 733-3636
Mailing address
16710 VIA LOS CABALLEROS, RIVERSIDE, CA 92504-6172
(951) 591-1516
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
0917
WY
225200000X
Physical Therapy Assistant
Primary
2122305
TX
Other
Enumeration date
09/17/2018
Last updated
09/17/2018
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