Provider Demographics
NPI:1548868706
Name:MARTE, JAIRO (LMBT)
Entity type:Individual
Prefix:
First Name:JAIRO
Middle Name:
Last Name:MARTE
Suffix:
Gender:M
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4058 GUNSMITH CT
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-7787
Mailing Address - Country:US
Mailing Address - Phone:336-482-5110
Mailing Address - Fax:
Practice Address - Street 1:2311 W CONE BLVD STE 121
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-4042
Practice Address - Country:US
Practice Address - Phone:336-482-5110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-11
Last Update Date:2020-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13910225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist