Individual
MS. KENNESHIA M MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13135 EARLY RUN LANE, RIVERVIEW, FL 33578
(813) 564-5468
Mailing address
PO BOX 3836, BRANDON, FL 33509-3836
(813) 564-5468
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA003385
GA
Other
Enumeration date
10/15/2019
Last updated
10/07/2020
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