Provider Demographics
NPI:1982752242
Name:MARTIN, MARY ANN (LMP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:MARTIN
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:PO BOX 3321
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2059
Mailing Address - Country:US
Mailing Address - Phone:509-326-0808
Mailing Address - Fax:509-533-9300
Practice Address - Street 1:104 S. FREYA ST.
Practice Address - Street 2:LILAC FLAG BLDG., STE 117A
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2059
Practice Address - Country:US
Practice Address - Phone:509-326-0808
Practice Address - Fax:509-533-9300
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019432225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist