Provider Demographics
NPI:1780933622
Name:BIRRENKOTT, LUNETTE R (PT)
Entity type:Individual
Prefix:
First Name:LUNETTE
Middle Name:R
Last Name:BIRRENKOTT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 N MASON AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-4934
Mailing Address - Country:US
Mailing Address - Phone:253-756-6458
Mailing Address - Fax:
Practice Address - Street 1:4120 N MASON AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-4934
Practice Address - Country:US
Practice Address - Phone:253-756-6458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006306225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist