Active NPI
Kelly Christine Martin, PTA
- Physical Therapy Assistant
- Washta, IA
National Provider Identifier
1851629547
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 01131
- Practice address
- 453 640TH St
Washta, IA 51061-7024 - Phone
- (712) 213-8674
- Fax
- (712) 743-5013
- NPI assigned
- Nov 18, 2009
- Last updated
- Nov 18, 2009
- Sex
- Female
- 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 Therapy Assistant | 225200000X | 01131 | IA | Primary |
Addresses
Primary practice location
453 640TH St
Washta, IA 51061-7024
Mailing address
453 640TH St
Washta, IA 51061-7024
Phone (712) 213-8674
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01131 | IA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1258502400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1258502400000",
"number": "1851629547",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "453 640TH ST",
"city": "WASHTA",
"state": "IA",
"postal_code": "510617024",
"telephone_number": "712-213-8674",
"fax_number": "712-743-5013"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "453 640TH ST",
"city": "WASHTA",
"state": "IA",
"postal_code": "510617024",
"telephone_number": "712-213-8674",
"fax_number": "712-743-5013"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "KELLY",
"middle_name": "CHRISTINE",
"name_prefix": "Mrs.",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-11-18",
"last_updated": "2009-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IA",
"license": "01131",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.