Provider Demographics
NPI:1861694176
Name:KRESLIN, MARTIN (LMT, NMT)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:KRESLIN
Suffix:
Gender:M
Credentials:LMT, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32402-0051
Mailing Address - Country:US
Mailing Address - Phone:850-814-8284
Mailing Address - Fax:
Practice Address - Street 1:2629 W 23RD ST STE E
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-2366
Practice Address - Country:US
Practice Address - Phone:850-814-8284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA11340225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist