1598826083 NPI number — MS. MARTHA KATHLEEN JARVIS MS PT ATCL

Table of content: MS. MARTHA KATHLEEN JARVIS MS PT ATCL (NPI 1598826083)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598826083 NPI number — MS. MARTHA KATHLEEN JARVIS MS PT ATCL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JARVIS
Provider First Name:
MARTHA
Provider Middle Name:
KATHLEEN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS PT ATCL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CABALLERO-JARVIS
Provider Other First Name:
KATHLEEN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1598826083
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 700097
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT CLOUD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34770-0097
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-957-6290
Provider Business Mailing Address Fax Number:
407-891-9183

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4237 13TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT CLOUD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34769-6732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-957-6290
Provider Business Practice Location Address Fax Number:
407-891-9183
Provider Enumeration Date:
12/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT10828 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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