MEDICARE: MS. MARTHA KELLY HOWE PT

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	1100212	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	8FAV99	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1669405320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARTHA KELLY HOWE PT

Provider Business Mailing Address
First Line	:	PO BOX 2603
Second Line	:	HTN, CLIENT ACCOUNTING
City	:	FORT WORTH
State	:	TX
Zip	:	76113-2603
Country	:	US
Telephone Number	:	817-569-4300
Fax Number	:

Provider Business Practice Location Address
First Line	:	3840 HULEN ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-7277
Country	:	US
Telephone Number	:	817-569-4300
Fax Number	:

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

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	03/18/2016

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