Healthcare Provider Details

I. General information

NPI: 1275779993
Provider Name (Legal Business Name): LIZOTTE P & O ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2008
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 S CEDAR ST
TACOMA WA
98405-2301
US

IV. Provider business mailing address

1902 S CEDAR ST
TACOMA WA
98405-2301
US

V. Phone/Fax

Practice location:
  • Phone: 253-761-9255
  • Fax: 253-752-7829
Mailing address:
  • Phone: 253-761-9255
  • Fax: 253-752-7829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number602765858
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number0I00000335
License Number StateWA

VIII. Authorized Official

Name: MR. THOMAS WILLIAM LIZOTTE JR.
Title or Position: OWNER/ LCPO
Credential: LCPO
Phone: 253-761-9255