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General NPI Number Information
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NPI Number | 1912654104
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Entity Type | Individual
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Provider Name | LYSETTE OQUENDO DPT
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Gender | Female
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Dates
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Enumeration Date | 03/07/2022
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 4755 S 48TH ST
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City | TACOMA
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State | WA
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Zip | 98409-1919
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Country | US
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Telephone | 321-375-3598
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Fax |
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Provider Business Mailing Address
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Address Line | 3952 JOSLIN WAY
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City | WEST MELBOURNE
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State | FL
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Zip | 32904-8489
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Country | US
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Telephone | 321-375-3598
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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 | PT61675887
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License Number State | WA
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