Provider Demographics
NPI:1104293950
Name:MARTINIS, KYLE EDWIN (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:EDWIN
Last Name:MARTINIS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 WINTHROP ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:REHOBOTH
Mailing Address - State:MA
Mailing Address - Zip Code:02769-2601
Mailing Address - Country:US
Mailing Address - Phone:774-565-0796
Mailing Address - Fax:774-565-8346
Practice Address - Street 1:65 HOLBROOK ST STE 130
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:MA
Practice Address - Zip Code:02056-1849
Practice Address - Country:US
Practice Address - Phone:774-565-0796
Practice Address - Fax:774-565-8346
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1264012225100000X
MA22262225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist