Provider Demographics
NPI:1093347700
Name:MARTIN, KEVIN CHARLES (PT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:CHARLES
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 WOODVIEW RD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-3050
Mailing Address - Country:US
Mailing Address - Phone:614-795-5550
Mailing Address - Fax:
Practice Address - Street 1:170 TAYLOR STATION RD STE 220
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-4491
Practice Address - Country:US
Practice Address - Phone:614-866-8158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH9081225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist