Individual
VIVIAN MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
432 SOUTH 9TH, JAY, OK 74346
(918) 253-4511
Mailing address
PO BOX 370, JAY, OK 74346-0370
(918) 253-4511
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1880
OK
Other
Enumeration date
04/17/2017
Last updated
04/17/2017
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