Healthcare Provider Details

I. General information

NPI: 1780733634
Provider Name (Legal Business Name): DARRELL EUGENE MARTIN LMP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5355 TALLMAN AVE NW STE 215
SEATTLE WA
98107-3953
US

IV. Provider business mailing address

5355 TALLMAN AVE NW STE 215
SEATTLE WA
98107-3953
US

V. Phone/Fax

Practice location:
  • Phone: 206-300-5399
  • Fax: 206-675-1043
Mailing address:
  • Phone: 206-300-5399
  • Fax: 206-675-1043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA00008870
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00008870
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: