Provider Demographics
NPI:1588017339
Name:MESA MARTINEZ, KYRA MARIE (PT)
Entity Type:Individual
Prefix:
First Name:KYRA
Middle Name:MARIE
Last Name:MESA MARTINEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KYRA
Other - Middle Name:MARIE
Other - Last Name:WEEMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:350 W WILSON BRIDGE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2217
Mailing Address - Country:US
Mailing Address - Phone:614-895-8747
Mailing Address - Fax:614-895-3246
Practice Address - Street 1:350 W WILSON BRIDGE RD STE 200
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085
Practice Address - Country:US
Practice Address - Phone:614-895-8747
Practice Address - Fax:614-895-3246
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT016363225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist