Basic Information
| Provider Information | |||||||||
| NPI: | 1639103450 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | COLIN | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1110 TWIN PINES CIR | ||||||||
| Address2: | |||||||||
| City: | TUSCUMBIA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356747704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563321871 | ||||||||
| FaxNumber: | 2563507757 | ||||||||
| Practice Location | |||||||||
| Address1: | 14001 HIGHWAY 43 | ||||||||
| Address2: | FRANKLIN PLAZA SUITE 18 & 19 | ||||||||
| City: | RUSSELLVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356532848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563310070 | ||||||||
| FaxNumber: | 2563310054 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | PTH2329 | AL | Y | Other Service Providers | Specialist |
No ID Information.