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General NPI Number Information
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NPI Number | 1013432053
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Entity Type | Individual
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Provider Name | KATIE MARTIN PTA
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Gender | Female
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Dates
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Enumeration Date | 08/10/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 10000 W 75TH ST STE 250
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City | MERRIAM
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State | KS
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Zip | 66204-2218
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Country | US
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Telephone | 888-913-1910
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Fax | 877-913-1174
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Provider Business Mailing Address
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Address Line | 10000 W 75TH ST STE 250
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City | MERRIAM
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State | KS
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Zip | 66204-2218
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Country | US
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Telephone | 888-913-1910
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Fax | 877-913-1174
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2017025031
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License Number State | MO
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