Provider Demographics
NPI:1588091151
Name:KOWALKE, MARTINA (LMP)
Entity type:Individual
Prefix:
First Name:MARTINA
Middle Name:
Last Name:KOWALKE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 STONE CREEK CIR SW
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-9127
Mailing Address - Country:US
Mailing Address - Phone:832-948-0625
Mailing Address - Fax:425-292-0402
Practice Address - Street 1:106 W NORTH BEND WAY
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98045-8150
Practice Address - Country:US
Practice Address - Phone:832-948-0625
Practice Address - Fax:425-292-0402
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60381693225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist