Provider Demographics
NPI:1104804277
Name:MARTYN, JENNIFER A (PT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:A
Last Name:MARTYN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7711 196TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98053
Mailing Address - Country:US
Mailing Address - Phone:206-782-5555
Mailing Address - Fax:425-868-9922
Practice Address - Street 1:7711 196TH AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98053
Practice Address - Country:US
Practice Address - Phone:206-782-5555
Practice Address - Fax:425-868-9922
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006837225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4287MAOtherREGENCE BLUE SHIELD
WA8430423Medicaid
WA4287MAOtherREGENCE BLUE SHIELD