MEDICARE: MINDY MARTIN MPT

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	7107	CO

General Provider Information

NPI Number	:	1902101421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINDY MARTIN MPT

Provider Business Mailing Address
First Line	:	8245 DOLLY MADISON DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-7043
Country	:	US
Telephone Number	:	719-282-1888
Fax Number	:

Provider Business Practice Location Address
First Line	:	2999 NEW CENTER PT
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80922-2806
Country	:	US
Telephone Number	:	719-365-5842
Fax Number	:	719-365-6878

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

Provider Enumeration Date	:	01/13/2011
Last Update Date	:	04/07/2020

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Directions to “ MINDY MARTIN MPT” Practice Location

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