Healthcare Provider Details

I. General information

NPI: 1740116714
Provider Name (Legal Business Name): THOMAS MARTIN RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 CLEMATIS CT
LYNDEN WA
98264-9577
US

IV. Provider business mailing address

1513 CLEMATIS CT
LYNDEN WA
98264-9577
US

V. Phone/Fax

Practice location:
  • Phone: 360-224-9259
  • Fax:
Mailing address:
  • Phone: 360-224-9259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRESP.LR.60505224
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: