Provider Demographics
NPI:1922015270
Name:MARTIN, KARI ANN (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:KARI
Middle Name:ANN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MISS
Other - First Name:KARI
Other - Middle Name:ANN
Other - Last Name:LATHWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:PO BOX 3497
Mailing Address - Street 2:
Mailing Address - City:STURTEVANT
Mailing Address - State:WI
Mailing Address - Zip Code:53177-0300
Mailing Address - Country:US
Mailing Address - Phone:877-552-2996
Mailing Address - Fax:866-245-8064
Practice Address - Street 1:841 S SAGINAW RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4664
Practice Address - Country:US
Practice Address - Phone:866-625-3570
Practice Address - Fax:989-631-3275
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010419225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN75070004Medicare PIN