Provider Demographics
NPI:1902992928
Name:MARTIN, LAURA M (PT)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:M
Other - Last Name:JOHNSTONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:805 MADISON ST
Mailing Address - Street 2:SUITE 901
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1172
Mailing Address - Country:US
Mailing Address - Phone:206-264-8100
Mailing Address - Fax:
Practice Address - Street 1:7320 216TH ST SW
Practice Address - Street 2:SUITE 320
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8006
Practice Address - Country:US
Practice Address - Phone:425-673-3916
Practice Address - Fax:425-673-3926
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009366225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8851485Medicare ID - Type Unspecified