Provider Demographics
NPI:1942323381
Name:DUVAL, MARTHA (LMP)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:DUVAL
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 1:1425 S PUGET DR APT 102
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-4327
Mailing Address - Country:US
Mailing Address - Phone:206-618-3642
Mailing Address - Fax:
Practice Address - Street 1:1425 S PUGET DR APT 102
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-4327
Practice Address - Country:US
Practice Address - Phone:206-618-3642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019862225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist