Provider Demographics
NPI:1568904274
Name:MCMARTIN, WILLIAM KIRK (DPT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:KIRK
Last Name:MCMARTIN
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 1:1010 S ALLANTE PL STE 101
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-1660
Mailing Address - Country:US
Mailing Address - Phone:208-370-5166
Mailing Address - Fax:208-370-5167
Practice Address - Street 1:1010 S ALLANTE PL STE 101
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-1660
Practice Address - Country:US
Practice Address - Phone:208-370-5166
Practice Address - Fax:208-370-5167
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-11
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID4195225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist