Dr. Lisa PT LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

DR. LISA PT LLC

Practice address

1794 Round Lake Rd
Interlochen, MI 49643-8435

Phone

(305) 467-9421

Fax

(305) 686-2397

NPI assigned

Jun 15, 2022

Organization subpart

No

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

Authorized official

Name

Lisa FernandezNPI 1881966067

Title

Owner/Managing Member

Phone

(305) 467-9421

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lisa Fernandez, DPT

  • Physical Therapist
  • Interlochen, MI
  • NPI 1881966067

  FL

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1655251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787011200000",
    "number": "1073243762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1794 ROUND LAKE RD",
            "city": "INTERLOCHEN",
            "state": "MI",
            "postal_code": "496438435",
            "telephone_number": "305-467-9421",
            "fax_number": "305-686-2397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1794 ROUND LAKE RD",
            "city": "INTERLOCHEN",
            "state": "MI",
            "postal_code": "496438435",
            "telephone_number": "305-467-9421",
            "fax_number": "305-686-2397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. LISA PT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-15",
        "last_updated": "2026-08-18",
        "certification_date": "2026-08-18",
        "status": "A",
        "authorized_official_last_name": "FERNANDEZ",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "OWNER/MANAGING MEMBER",
        "authorized_official_telephone_number": "305-467-9421"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crystal Lake Clinic P.C.
• Irene S Danek, M.D.
• Debra E Lewis DDS, PC
• Noel N Demerly, RD
• Nancy Lee Dorman, FNP-C
• Dawn Edgley
• Lisa Fernandez, DPT
• Dawn Marie Gaden, M.A., L.P.C., N.C.C.
• Goodwill Optical Inc (Good Eyes Optical)
• Ashley Marie Goss, FNP-C

• Physical Therapy Clinic/Center in Interlochen, MI
• Providers in Interlochen, MI by specialty
• Physical Therapy Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.