Active NPI
Keith Alan Martin, M.S., PT
- Physical Therapist
- Indianapolis, IN
National Provider Identifier
1285803270
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 05003478A
- Practice address
- 6640 Parkdale PL Ste T
Indianapolis, IN 46254-5619 - Phone
- (317) 808-7070
- Fax
- (317) 808-7073
- NPI assigned
- Feb 25, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 05003478A | IN | Primary |
Addresses
Primary practice location
6640 Parkdale PL Ste T
Indianapolis, IN 46254-5619
Mailing address
33900 Harper Ave Ste 104
Clinton TWP, MI 48035-4258
Phone (586) 350-2644
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 255388 | Other | IN | ANTHEM/BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203897600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1550534400000",
"number": "1285803270",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "33900 HARPER AVE STE 104",
"city": "CLINTON TWP",
"state": "MI",
"postal_code": "480354258",
"telephone_number": "586-350-2644"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6640 PARKDALE PL STE T",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462545619",
"telephone_number": "317-808-7070",
"fax_number": "317-808-7073"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "KEITH",
"middle_name": "ALAN",
"name_prefix": "Mr.",
"credential": "M.S., PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-02-25",
"last_updated": "2019-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IN",
"license": "05003478A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM/BCBS",
"identifier": "255388",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.