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Individual
KELLY CATHERINE MARTIN
Active
Individual
KELLY CATHERINE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5148
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
804894012
BLUE CROSS
OR
01
—
J284217
PACIFIC SOURCE
OR
Enumeration date
12/21/2006
Last updated
12/13/2021
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