Provider Demographics
NPI:1487833760
Name:BARR, MARTIN DALE (BS, LMP)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:DALE
Last Name:BARR
Suffix:
Gender:M
Credentials:BS, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4444 WOODLAND PARK AVE N
Mailing Address - Street 2:SUITE 115
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-7429
Mailing Address - Country:US
Mailing Address - Phone:206-310-2823
Mailing Address - Fax:206-547-5883
Practice Address - Street 1:4444 WOODLAND PARK AVE N
Practice Address - Street 2:SUITE 115
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-7429
Practice Address - Country:US
Practice Address - Phone:206-310-2823
Practice Address - Fax:206-547-5883
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022658225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist