Active NPI
Becky Joann Martin, PTA
- Physical Therapy Clinic/Center
- Pueblo, CO
National Provider Identifier
1104116003
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Clinic/Center
- License
- 311679605
- Practice address
- 100 San Carlos Rd Apt 310
Pueblo, CO 81005-2665 - Phone
- (719) 564-2370
- NPI assigned
- Apr 12, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Clinic/Center | 261QP2000X | 311679605 | CO | Primary |
Addresses
Primary practice location
100 San Carlos Rd Apt 310
Pueblo, CO 81005-2665
Mailing address
100 San Carlos Rd Apt 310
Pueblo, CO 81005-2665
Phone (719) 564-2370
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0012683 | Other | CO | COLORADO PTA-C |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 311679605 | CO | MD | Physical Therapy Clinic/Center |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1302566400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1432080000000",
"number": "1104116003",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 SAN CARLOS RD APT 310",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810052665",
"telephone_number": "719-564-2370"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 SAN CARLOS RD APT 310",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810052665",
"telephone_number": "719-564-2370"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "BECKY",
"middle_name": "JOANN",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-04-12",
"last_updated": "2015-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "261QP2000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Physical Therapy",
"state": "CO",
"license": "311679605",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COLORADO PTA-C",
"identifier": "0012683",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.