MEDICARE: DR. KETSIA KEREN MARTIN PT, 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	28899	MD

General Provider Information

NPI Number	:	1841956406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KETSIA KEREN MARTIN PT, DPT

Provider Business Mailing Address
First Line	:	10100 TWIN RIVERS RD APT 351
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21044-2580
Country	:	US
Telephone Number	:	914-819-3945
Fax Number	:

Provider Business Practice Location Address
First Line	:	8600 LASALLE RD STE 335
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21286
Country	:	US
Telephone Number	:	410-823-0880
Fax Number	:

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

Provider Enumeration Date	:	11/09/2021
Last Update Date	:	04/25/2026

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