Provider Demographics
NPI:1760007785
Name:MARTINEZ, BAILEY (LMT, CEP)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LMT, CEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10300 SW GREENBURG RD STE 195
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5414
Mailing Address - Country:US
Mailing Address - Phone:360-929-4539
Mailing Address - Fax:
Practice Address - Street 1:10300 SW GREENBURG RD STE 195
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-5414
Practice Address - Country:US
Practice Address - Phone:360-929-4539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25558225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist