Individual
MR. KEITH ALAN MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S., PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05003478A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
255388
ANTHEM/BCBS
IN
Enumeration date
02/25/2008
Last updated
02/19/2019
Update your record
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