Individual
MR. KENNETH MICHAEL MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT MT
Contact information
Practice address
2700 LAKE VILLA DR STE 100, METAIRIE, LA 70002-6782
(504) 888-7333
(504) 888-1052
Mailing address
2700 LAKE VILLA DR STE 100, METAIRIE, LA 70002-6782
(504) 888-7333
(504) 888-1052
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT01637
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52918
BLUE CROSS
—
Enumeration date
01/22/2007
Last updated
04/25/2019
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