Provider Demographics
NPI:1174858690
Name:MARTIN, ADAM PATRICK (DPT)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:PATRICK
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11481 SW HALL BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8403
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:23505 E APPLEWAY AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-6003
Practice Address - Country:US
Practice Address - Phone:509-891-2258
Practice Address - Fax:509-891-2094
Is Sole Proprietor?:No
Enumeration Date:2009-10-16
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-2577225100000X
WAPT60124066225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1174858690Medicaid
ID1174858690-001Medicaid
ID808561200Medicaid
ID1652836Medicare PIN
WAG8893081Medicare PIN