MEDICARE: MARTIN MATNEY ATC, PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1073514519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIN MATNEY ATC, PTA

Provider Business Mailing Address
First Line	:	11110 NE 100TH ST
Second Line	:
City	:	KIRKLAND
State	:	WA
Zip	:	98033-5117
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13120 NE 70TH PL
Second Line	:	SUITE 3
City	:	KIRKLAND
State	:	WA
Zip	:	98033-8570
Country	:	US
Telephone Number	:	425-889-0776
Fax Number	:	425-889-0857

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/08/2007

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