| Doctor Name: | DUSTIN DARYL MARTINSON |
| NPI Number: | 1073701116 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT |
| License Number: | PT1215 |
| Business Practice Address: | 1103 E Boxelder Rd Ste U Gillette, WY - 827185582 |
| Business Phone Number: | 3076868177 |
| Business Fax Number: | |
| Mailing Address: | 1103 E Boxelder Rd, Ste U GILLETTE |
| State: | WY |
| Postal Code: | 827185582 |
| Phone Number: | 2082881155 |
| Fax Number: | 2082880424 |
| NPI Enumeration Date: | 10/12/2007 |
| NPI Last Update Date: | 09/02/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | PT1215 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WY |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |