Provider Demographics
NPI:1124602909
Name:MUCKLER, MARTINA
Entity type:Individual
Prefix:MS
First Name:MARTINA
Middle Name:
Last Name:MUCKLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5109 STONEY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-9261
Mailing Address - Country:US
Mailing Address - Phone:605-415-3903
Mailing Address - Fax:605-231-4312
Practice Address - Street 1:2030 JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-3481
Practice Address - Country:US
Practice Address - Phone:605-415-3903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-08
Last Update Date:2021-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty