Provider Demographics
NPI:1275779993
Name:LIZOTTE P & O ASSOCIATES LLC
Entity Type:Organization
Organization Name:LIZOTTE P & O ASSOCIATES LLC
Other - Org Name:WASHINGTON ORTHOTICS & PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ LCPO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:WILLIAM
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 1:1902 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2301
Practice Address - Country:US
Practice Address - Phone:253-761-9255
Practice Address - Fax:253-752-7829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-30
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA222Z00000X
WA0I00000335224P00000X
WA602765858335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9036963Medicaid
WA9061912Medicaid
WA6030520001Medicare NSC