Provider Demographics
NPI:1922588243
Name:MARTINEZ, THAO MAI (DPT)
Entity Type:Individual
Prefix:
First Name:THAO
Middle Name:MAI
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:THAO
Other - Middle Name:MAI
Other - Last Name:1679123582
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24127 9TH CT S
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-5216
Mailing Address - Country:US
Mailing Address - Phone:206-375-7274
Mailing Address - Fax:
Practice Address - Street 1:11435 80TH PL S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98178-3649
Practice Address - Country:US
Practice Address - Phone:425-243-3149
Practice Address - Fax:425-207-4980
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291660225100000X
WA60881077225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist