Provider Demographics
NPI:1609193275
Name:JAVIER, MARTILENNY (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MARTILENNY
Middle Name:
Last Name:JAVIER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8361 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:FT LEWIS
Mailing Address - State:WA
Mailing Address - Zip Code:98433-1320
Mailing Address - Country:US
Mailing Address - Phone:910-286-9529
Mailing Address - Fax:
Practice Address - Street 1:6220 S ALASKA ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-1317
Practice Address - Country:US
Practice Address - Phone:253-476-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-22
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160135007172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker