MEDICARE: KATHERINE ANNE MARTIN DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT7264	MS

General Provider Information

NPI Number	:	1093460768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE ANNE MARTIN DPT

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:	423-206-4158
Fax Number	:	717-773-4654

Provider Business Practice Location Address
First Line	:	6156 HIGHWAY 98
Second Line	:	SUITE 70
City	:	HATTIESBURG
State	:	MS
Zip	:	39402-8155
Country	:	US
Telephone Number	:	601-336-7155
Fax Number	:	601-336-7782

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2022
Last Update Date	:	02/21/2022

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