Provider Demographics
NPI:1871665315
Name:MARTINEZ, BRANDY L (LMP)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:L
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 BRANDT RD 36
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661
Mailing Address - Country:US
Mailing Address - Phone:360-513-1263
Mailing Address - Fax:
Practice Address - Street 1:6808 NE FOURTH PLAIN BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-0217
Practice Address - Country:US
Practice Address - Phone:360-750-7220
Practice Address - Fax:360-750-4488
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017308225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist