Provider Demographics
NPI:1316058068
Name:LIRETTE, JOSEPH (PT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:LIRETTE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3715 S HUDSON ST
Mailing Address - Street 2:STE 103
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-2171
Mailing Address - Country:US
Mailing Address - Phone:206-985-2236
Mailing Address - Fax:206-985-2248
Practice Address - Street 1:7900 E GREEN LAKE DR N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-4800
Practice Address - Country:US
Practice Address - Phone:206-985-2236
Practice Address - Fax:206-985-2248
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT8378225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA165615OtherLABOR & INDUSTRIES
WA8339988Medicaid
WA50-6570Medicare ID - Type UnspecifiedMEDICARE