Provider Demographics
NPI:1285072074
Name:MARTIN, JEFFREY EUGENE (PT, DPT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:EUGENE
Last Name:MARTIN
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 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:
Practice Address - Street 1:4800 W 135TH ST STE 210
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66224-8722
Practice Address - Country:US
Practice Address - Phone:913-766-9816
Practice Address - Fax:913-766-6813
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002025838225100000X
KS11-3213225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist