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Individual

THERESA K MARTIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
11212 SUNRISE BLVD E, #201, PUYALLUP, WA 98374-8847
(253) 697-7550
Mailing address
11212 SUNRISE BLVD E, #201, PUYALLUP, WA 98374-8847
(253) 697-7550

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA60071585
WA
363AM0700X
Medical Physician Assistant
PA60071585
WA
363AS0400X
Surgical Physician Assistant
Primary
PA60071585
WA
363AS0400X
Surgical Physician Assistant
PA9103689
FL

Other

Enumeration date
05/31/2006
Last updated
07/17/2012
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