Healthcare Provider Details

I. General information

NPI: 1952271983
Provider Name (Legal Business Name): KAYTLIN HARRIS-MARTIN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2025
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9229 E 37TH ST N STE 201
WICHITA KS
67226-2025
US

IV. Provider business mailing address

6122 S ELLIS AVE
WICHITA KS
67216-4047
US

V. Phone/Fax

Practice location:
  • Phone: 316-655-3403
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: