Provider Demographics
NPI:1124252192
Name:MARTIN, JOSEPH KERVIN (PT)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:KERVIN
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 SAINT JAMES DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-5914
Mailing Address - Country:US
Mailing Address - Phone:337-654-4542
Mailing Address - Fax:337-984-1097
Practice Address - Street 1:216 SAINT JAMES DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-5914
Practice Address - Country:US
Practice Address - Phone:337-654-4542
Practice Address - Fax:337-984-1097
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA02437R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist