Healthcare Provider Details

I. General information

NPI: 1093460768
Provider Name (Legal Business Name): KATHERINE ANNE MARTIN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2022
Last Update Date: 02/21/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6156 HIGHWAY 98 SUITE 70
HATTIESBURG MS
39402-8155
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 601-336-7155
  • Fax: 601-336-7782
Mailing address:
  • Phone: 423-206-4158
  • Fax: 717-773-4654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT7264
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: