Healthcare Provider Details

I. General information

NPI: 1992526040
Provider Name (Legal Business Name): LLOIDD LORRAINNE APP DUQUE DIZON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 DEXTER AVE N STE 320
SEATTLE WA
98109-4878
US

IV. Provider business mailing address

1650 LYNDON FARM CT STE 300
LOUISVILLE KY
40223-5005
US

V. Phone/Fax

Practice location:
  • Phone: 206-486-3344
  • Fax: 206-832-4733
Mailing address:
  • Phone: 813-560-8157
  • Fax: 812-590-8333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT61601014
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: