MEDICARE: MR. KIM MARTIN P.T.

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	2251G0304X	Geriatric Physical Therapist	1033884	TX

General Provider Information

NPI Number	:	1447841044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KIM MARTIN P.T.

Provider Business Mailing Address
First Line	:	23 KRAMER LN
Second Line	:
City	:	SANGER
State	:	TX
Zip	:	76266-5782
Country	:	US
Telephone Number	:	325-226-3364
Fax Number	:

Provider Business Practice Location Address
First Line	:	3401 AMADOR DR
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76177-2227
Country	:	US
Telephone Number	:	682-204-0853
Fax Number	:

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

Provider Enumeration Date	:	01/27/2021
Last Update Date	:	01/27/2021

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Directions to “ MR. KIM MARTIN P.T.” Practice Location

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