Dodge Therapy LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

DODGE THERAPY LLC

Doing business as

Fyzical Therapy and Balance Centers

Practice address

16109 S Farrell Rd
Lockport, IL 60441-8200

Phone

(847) 848-4011

NPI assigned

May 5, 2021

Organization subpart

No

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

Authorized official

Name

Kyle DodgeNPI 1720434467

Title

Owner

Phone

(847) 848-4011

Specialties & licenses 1

Addresses

Other names 1

• Fyzical Therapy and Balance Centers Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Practitioners 4

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

• Kyle Dodge, DPT

  • Physical Therapist
  • Mokena, IL
  • NPI 1720434467
  Medicare reassignment Care Compare group NPD Authorized official
• Kayla Lane Sierzega, PT, DPT

  • Physical Therapist
  • Lockport, IL
  • NPI 1568163483
  Medicare reassignment Care Compare group NPD
• Grant A Bullock

  • Psychiatry Physician
  • Las Vegas, NV
  • NPI 1174086391
  NPD
• Ailene Ally Elizabeth Wade, PA

  • Physician Assistant
  • Frankfort, IL
  • NPI 1942082821
  NPD (past)

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

{
    "created_epoch": "1620172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637280000000",
    "number": "1083297196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16109 S FARRELL RD",
            "city": "LOCKPORT",
            "state": "IL",
            "postal_code": "604418200",
            "telephone_number": "847-848-4011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16109 S FARRELL RD",
            "city": "LOCKPORT",
            "state": "IL",
            "postal_code": "604418200",
            "telephone_number": "847-848-4011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DODGE THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-05",
        "last_updated": "2021-11-19",
        "certification_date": "2021-11-19",
        "status": "A",
        "authorized_official_last_name": "DODGE",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-848-4011"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fyzical Therapy and Balance Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Elsy A Devassy, M.D.
• Violeta G Diaz Magana
• Kristen Noelle Dickinson
• Divine Heart Home Care LLC
• Djordjevic Dental PLLC
• Julia Dombrow, LCPC
• Matthew Doser
• Abigail Dujka, MS, RDN, LDN
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• Physical Therapist in Lockport, IL
• Providers in Lockport, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2021; 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.