Provider Demographics
NPI:1598798134
Name:MARTIN, KRISTINA M (MPT)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:M
Other - Last Name:GODFREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:660 GLADES RD
Mailing Address - Street 2:SUITE 460
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6465
Mailing Address - Country:US
Mailing Address - Phone:561-391-5515
Mailing Address - Fax:561-862-5386
Practice Address - Street 1:660 GLADES RD
Practice Address - Street 2:SUITE 460
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6465
Practice Address - Country:US
Practice Address - Phone:561-391-5515
Practice Address - Fax:561-862-5386
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19671225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAK944ZMedicare UPIN