Provider Demographics
NPI:1902127905
Name:BOREN, MARTIN J (CRT, RRT)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:J
Last Name:BOREN
Suffix:
Gender:M
Credentials:CRT, RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8704 NORTHGATE LN
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-3206
Mailing Address - Country:US
Mailing Address - Phone:501-352-7604
Mailing Address - Fax:
Practice Address - Street 1:8704 NORTHGATE LN
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-3206
Practice Address - Country:US
Practice Address - Phone:501-352-7604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR-T1045227800000X, 227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified
No227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered