Healthcare Provider Details

I. General information

NPI: 1841956406
Provider Name (Legal Business Name): KETSIA KEREN MARTIN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KETSIA KEREN MACENA PT, DPT

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 LASALLE RD STE 335
TOWSON MD
21286
US

IV. Provider business mailing address

10100 TWIN RIVERS RD APT 351
COLUMBIA MD
21044-2580
US

V. Phone/Fax

Practice location:
  • Phone: 410-823-0880
  • Fax:
Mailing address:
  • Phone: 914-819-3945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number28899
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: