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General NPI Number Information
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NPI Number | 1316018583
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Entity Type | Organization
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Legal Business Name | PACIFIC PROSTHETICS AND ORTHOTICS, LLC
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Dates
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Enumeration Date | 11/10/2006
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Last Update Date | 10/29/2009
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Provider Practice Location Address
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Address Line | 322 SW 155TH ST SUITE C
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City | BURIEN
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State | WA
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Zip | 98166-2590
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Country | US
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Telephone | 206-246-8910
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Fax | 206-242-0165
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Provider Business Mailing Address
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Address Line | 408 64TH AVENUE CT E
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City | TACOMA
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State | WA
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Zip | 98424-1479
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Country | US
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Telephone | 206-246-8910
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Fax | 253-927-9153
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Authorized Official
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Title or Position | OWNER
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Name | MR. RAYMOND M FRIESZELL
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Credential | CPO
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Telephone | 206-246-8910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | PS000000555555
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License Number State | WA
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