Organization
PACIFIC PROSTHETICS AND ORTHOTICS, LLC
Active
Organization
PACIFIC PROSTHETICS AND ORTHOTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAYMOND M FRIESZELL CPO (OWNER)
(206) 246-8910
Entity
Organization
Contact information
Practice address
322 SW 155TH ST, SUITE C, BURIEN, WA 98166-2590
(206) 246-8910
(206) 242-0165
Mailing address
408 64TH AVENUE CT E, TACOMA, WA 98424-1479
(206) 246-8910
(253) 927-9153
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
PS000000555555
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
139008
LABOR AND INDUSTRIES
WA
01
—
2020PA
REGENCE BLUE SHIELD
WA
05
—
9049644
—
WA
Enumeration date
11/10/2006
Last updated
10/29/2009
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