MEDICARE: KYLE JAMES MARTINOS DPT

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	2251E1300X	Clinical Electrophysiology Physical Therapist	PTH8918	AL
2	2251E1300X	Clinical Electrophysiology Physical Therapist	12768	TN
3	225100000X	Physical Therapist	PTH8918	AL
4	225100000X	Physical Therapist		NM

General Provider Information

NPI Number	:	1942743422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE JAMES MARTINOS DPT

Provider Business Mailing Address
First Line	:	PO BOX 370
Second Line	:
City	:	FORTSON
State	:	GA
Zip	:	31808-0370
Country	:	US
Telephone Number	:
Fax Number	:	706-494-3008

Provider Business Practice Location Address
First Line	:	3832 E MAIN ST
Second Line	:	SUITE E
City	:	FARMINGTON
State	:	NM
Zip	:	87402-8749
Country	:	US
Telephone Number	:	505-258-4003
Fax Number	:	505-436-2740

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

Provider Enumeration Date	:	12/01/2016
Last Update Date	:	02/19/2026

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