Provider Demographics
NPI:1063780377
Name:LIZOTTE P&O ASSOCIATES LLC
Entity type:Organization
Organization Name:LIZOTTE P&O ASSOCIATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:LIZOTTE
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCPO
Authorized Official - Phone:253-761-9255
Mailing Address - Street 1:1902 S CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2301
Mailing Address - Country:US
Mailing Address - Phone:253-761-9255
Mailing Address - Fax:253-752-7829
Practice Address - Street 1:5605 100TH ST SW
Practice Address - Street 2:SUITE A
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2710
Practice Address - Country:US
Practice Address - Phone:253-301-3500
Practice Address - Fax:253-302-3426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0I00000335335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9036963Medicaid
WA6030520001Medicare NSC