Provider Demographics
NPI:1275953085
Name:MARTIN, RAECHAL (LAT, LMT)
Entity type:Individual
Prefix:
First Name:RAECHAL
Middle Name:
Last Name:MARTIN
Suffix:
Gender:
Credentials:LAT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12600 HILL COUNTRY BLVD
Mailing Address - Street 2:STE R-130 PMB 3057
Mailing Address - City:BEE CAVE
Mailing Address - State:TX
Mailing Address - Zip Code:78738
Mailing Address - Country:US
Mailing Address - Phone:512-643-4849
Mailing Address - Fax:
Practice Address - Street 1:12600 HILL COUNTRY BLVD
Practice Address - Street 2:STE R-130 PMB 3057
Practice Address - City:BEE CAVE
Practice Address - State:TX
Practice Address - Zip Code:78738
Practice Address - Country:US
Practice Address - Phone:512-643-4849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-18
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT78112255A2300X
TXMT132972225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer