Provider Demographics
NPI:1922276641
Name:MARTIN, SCOTT STEPHAN (RN, MPT)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:STEPHAN
Last Name:MARTIN
Suffix:
Gender:M
Credentials:RN, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 N NORTHGATE WAY
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8913
Mailing Address - Country:US
Mailing Address - Phone:206-525-1010
Mailing Address - Fax:206-523-9101
Practice Address - Street 1:1115 N NORTHGATE WAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8913
Practice Address - Country:US
Practice Address - Phone:206-525-1010
Practice Address - Fax:206-523-9101
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00078213163WG0000X
WAPT00005424225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice