Provider Demographics
NPI:1326673658
Name:MARTIN, MARIA KATHLEEN SANTOS (DPT)
Entity Type:Individual
Prefix:
First Name:MARIA KATHLEEN
Middle Name:SANTOS
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MARIA KATHLEEN
Other - Middle Name:INFANTE
Other - Last Name:SANTOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6105
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85261-6105
Mailing Address - Country:US
Mailing Address - Phone:480-712-4600
Mailing Address - Fax:602-428-7045
Practice Address - Street 1:19636 N 27TH AVE STE 106
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4014
Practice Address - Country:US
Practice Address - Phone:480-712-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292139225100000X
AZ10950225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA292139OtherLICENSED PHYSICAL THERAPIST
AZ10950OtherLICENSED PHYSICAL THERAPIST