Provider Demographics
NPI:1174921852
Name:MARTIN, DARLENE (MED, VATL, ATC)
Entity type:Individual
Prefix:PROF
First Name:DARLENE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MED, VATL, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1971 UNIVERSITY BLVD., MSC BOX 710162
Mailing Address - Street 2:LIBERTY UNIVERSITY, DEPT OF PUBLIC & COMMUNITY HEALTH
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24515
Mailing Address - Country:US
Mailing Address - Phone:434-592-4096
Mailing Address - Fax:434-582-7261
Practice Address - Street 1:1971 UNIVERSITY BLVD., MSC BOX 710162
Practice Address - Street 2:LIBERTY UNIVERSITY, DEPT OF PUBLIC & COMMUNITY HEALTH
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24515
Practice Address - Country:US
Practice Address - Phone:434-592-4096
Practice Address - Fax:434-582-7261
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-12
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260005232255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer