Healthcare Provider Details

I. General information

NPI: 1588671739
Provider Name (Legal Business Name): ALISHA MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26001 BARBER CUT OFF RD NE # C-1
KINGSTON WA
98346-8484
US

IV. Provider business mailing address

19319 7TH AVE NE STE 100
POULSBO WA
98370-7442
US

V. Phone/Fax

Practice location:
  • Phone: 360-297-7050
  • Fax: 360-297-7502
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00009258
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: