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General NPI Number Information
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NPI Number | 1649287582
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Entity Type | Individual
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Provider Name | LORI CHRISTINE VAN DUSEN DPT
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Gender | Female
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 06/25/2012
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Provider Practice Location Address
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Address Line | 3801 5TH ST. SE SUITE 220
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City | PUYALLUP
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State | WA
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Zip | 98374
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Country | US
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Telephone | 253-445-4258
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Fax | 253-445-4724
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Provider Business Mailing Address
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Address Line | 11711 NE 12TH STREET SUITE 3A
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City | BELLEVUE
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State | WA
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Zip | 98005
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Country | US
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Telephone | 425-450-9474
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Fax | 425-635-9340
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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 | PT00009546
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License Number State | WA
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