Provider Demographics
NPI:1689657538
Name:LEZAMIZ, BRETT NIKOL (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:NIKOL
Last Name:LEZAMIZ
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 116TH AVE NE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3034
Mailing Address - Country:US
Mailing Address - Phone:425-450-9801
Mailing Address - Fax:425-450-9778
Practice Address - Street 1:1605 116TH AVE NE
Practice Address - Street 2:SUITE 110
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3034
Practice Address - Country:US
Practice Address - Phone:425-450-9801
Practice Address - Fax:425-450-9778
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009488225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8854358Medicare ID - Type Unspecified
WA8429417Medicare ID - Type Unspecified