Provider Demographics
NPI:1659474997
Name:DOLPHINO, MARTIN R (RPT)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:R
Last Name:DOLPHINO
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 RAINBOW BLVD
Mailing Address - Street 2:4070 DELP, MS 4017
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160
Mailing Address - Country:US
Mailing Address - Phone:913-588-6100
Mailing Address - Fax:913-588-8186
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:ORTHOPEDIC SURGERY, MS 3017
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160
Practice Address - Country:US
Practice Address - Phone:913-588-6100
Practice Address - Fax:913-588-8186
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-032762251G0304X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
300103063OtherRAILROAD MEDICARE
MO489114801Medicaid
MO31813022OtherBCBS KC
KS100644020AMedicaid
300103063OtherRAILROAD MEDICARE
KS100644020AMedicaid