Individual
MR. KEITH ALAN MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S., PT
Contact information
Practice address
6640 PARKDALE PL STE T, INDIANAPOLIS, IN 46254-5619
(317) 808-7070
(317) 808-7073
Mailing address
33900 HARPER AVE STE 104, CLINTON TWP, MI 48035-4258
(586) 350-2644
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
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