MEDICARE: MARTIN KILBANE

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT09266	OTHER	OH	LICENSE#

General Provider Information

NPI Number	:	1740399310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIN KILBANE

Provider Business Mailing Address
First Line	:	19470 LAUREL AVE
Second Line	:
City	:	ROCKY RIVER
State	:	OH
Zip	:	44116-2708
Country	:	US
Telephone Number	:	440-333-2396
Fax Number	:

Provider Business Practice Location Address
First Line	:	671 COLUMBIA RD
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-1477
Country	:	US
Telephone Number	:	440-871-7767
Fax Number	:

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	07/08/2007

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Directions to “ MARTIN KILBANE ” Practice Location

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