Provider Demographics
NPI:1386190999
Name:MARTIN, JOSA JAMES (DPT)
Entity type:Individual
Prefix:
First Name:JOSA
Middle Name:JAMES
Last Name:MARTIN
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11855 ULYSSES ST NE STE 20
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-3949
Mailing Address - Country:US
Mailing Address - Phone:763-767-3140
Mailing Address - Fax:763-767-3146
Practice Address - Street 1:11855 ULYSSES ST NE STE 20
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-3949
Practice Address - Country:US
Practice Address - Phone:763-767-3140
Practice Address - Fax:763-767-3146
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10459225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist