Provider Demographics
NPI:1649287582
Name:VAN DUSEN, LORI CHRISTINE (DPT)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:CHRISTINE
Last Name:VAN DUSEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11711 NE 12TH STREET
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005
Mailing Address - Country:US
Mailing Address - Phone:425-450-9474
Mailing Address - Fax:425-635-9340
Practice Address - Street 1:3801 5TH ST. SE
Practice Address - Street 2:SUITE 220
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374
Practice Address - Country:US
Practice Address - Phone:253-445-4258
Practice Address - Fax:253-445-4724
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009546225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LI0189941OtherLABOR & INDUSTRIES
WA8409393Medicaid
LI0189941OtherLABOR & INDUSTRIES