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General NPI Number Information
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NPI Number | 1336085125
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Entity Type | Individual
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Provider Name | JAKE PABLITO LUSABE II DPT
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Gender | Male
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Dates
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Enumeration Date | 04/25/2026
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Last Update Date | 04/25/2026
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Provider Practice Location Address
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Address Line | 1560 3RD AVE
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City | LONGVIEW
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State | WA
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Zip | 98632-3229
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Country | US
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Telephone | 866-518-0283
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Fax |
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Provider Business Mailing Address
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Address Line | 1580 SAWGRASS CORPORATE PKWY STE 320
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City | SUNRISE
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State | FL
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Zip | 33323-2859
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Country | US
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Telephone | 954-739-4247
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT61406907
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License Number State | WA
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