MEDICARE: KAREN KAYE MARTINEZ CACANINDIN

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	070.024072	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	070.024072	OTHER	IL	ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION

General Provider Information

NPI Number	:	1275096547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN KAYE MARTINEZ CACANINDIN

Provider Business Mailing Address
First Line	:	5501 NICHOLS DR
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-2332
Country	:	US
Telephone Number	:	562-810-8008
Fax Number	:

Provider Business Practice Location Address
First Line	:	5501 NICHOLS DR
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-2332
Country	:	US
Telephone Number	:	562-810-8008
Fax Number	:

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

Provider Enumeration Date	:	04/12/2019
Last Update Date	:	02/11/2026

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