Provider Demographics
NPI:1740472752
Name:MARTIN, KAREN PANCOAST (PT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:PANCOAST
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ELLSWORTH CT
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-3016
Mailing Address - Country:US
Mailing Address - Phone:330-701-7234
Mailing Address - Fax:
Practice Address - Street 1:4 ELLSWORTH CT
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-3016
Practice Address - Country:US
Practice Address - Phone:330-701-7234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 0105392251X0800X
UT4796194-24012251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic