Provider Demographics
NPI:1750593703
Name:MARTIN, DAREN LAVEL (MPT)
Entity type:Individual
Prefix:
First Name:DAREN
Middle Name:LAVEL
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1977 DEWAR DR
Mailing Address - Street 2:STE J
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-5757
Mailing Address - Country:US
Mailing Address - Phone:307-382-3228
Mailing Address - Fax:
Practice Address - Street 1:1977 DEWAR DR
Practice Address - Street 2:STE. J
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5737
Practice Address - Country:US
Practice Address - Phone:307-382-3228
Practice Address - Fax:307-382-6886
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY995225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist