Marissa Anderson, DPT, PT

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

16804-24 Issued in WI

Practice address

805 Elm St
Lake Mills, WI 53551-1127

Phone

(920) 941-0464

Fax

(920) 648-2444

NPI assigned

Jun 5, 2024

Last updated

Jun 5, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physical Medicine and Rehabilitation

Education

Other, 2024

Medicare assignment

May accept Medicare assignment

Group practices

Optimal Physical Therapy LLCGroup PAC ID 6608894290, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Optimal Physical Therapy, LLC

  • Physical Therapist
  • Lake Mills, WI
  • NPI 1508887464
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1717545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717545600000",
    "number": "1033950894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 ELM ST",
            "city": "LAKE MILLS",
            "state": "WI",
            "postal_code": "535511127",
            "telephone_number": "920-941-0464",
            "fax_number": "920-648-2444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 ELM ST",
            "city": "LAKE MILLS",
            "state": "WI",
            "postal_code": "535511127",
            "telephone_number": "920-941-0464",
            "fax_number": "920-648-2444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "MARISSA",
        "credential": "DPT, PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-05",
        "last_updated": "2024-06-05",
        "certification_date": "2024-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "WI",
            "license": "16804-24",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aadvantage Behavioral Healthcare, LLC (Advantage Behavioral Healthcare, LLC)
• Align Doula Services LLC
• Gregory D Anderson, DC
• Leanne Anthon, RN
• Jill Armentrout
• Assisted Living Concepts Inc (Brook Gardens)
• Aurora Pharmacy Inc (Aurora Pharmacy)
• Elizabeth Frances Balsiger, MS, CCC-SLP

• Physical Medicine & Rehabilitation Physician in Lake Mills, WI
• Providers in Lake Mills, WI by specialty
• Physical Medicine & Rehabilitation Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.