Amy Wiskow, LMT – Massage Therapist in Marion, WI

Key facts

NPI: 1093414732
Entity type: Individual (NPI type 1)
Primary specialty: Massage Therapist 225700000X
License: 11991-146 (WI)
Practice address: W12710 US Highway 45
Marion, WI 54950-9153
Phone: (715) 853-3740
NPI assigned: Mar 2, 2023
Sex: Female
Sole proprietor: Yes

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
11991-146	WI	MD	Massage Therapist

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Massage Therapist	225700000X	11991-146	WI	Yes

Addresses

Primary practice location

W12710 US Highway 45
Marion, WI 54950-9153

Mailing address

E6081 Mavis Rd
Marion, WI 54950-9580
Phone (715) 853-3740

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 2, 2023.

{
    "created_epoch": "1677715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677715200000",
    "number": "1093414732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "E6081 MAVIS RD",
            "city": "MARION",
            "state": "WI",
            "postal_code": "549509580",
            "telephone_number": "715-853-3740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W12710 US HIGHWAY 45",
            "city": "MARION",
            "state": "WI",
            "postal_code": "549509153",
            "telephone_number": "715-853-3740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISKOW",
        "first_name": "AMY",
        "name_prefix": "Ms.",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-03-02",
        "last_updated": "2023-03-02",
        "certification_date": "2022-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WI",
            "license": "11991-146",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marion, WI

All providers in Marion, WI · Massage Therapist in Wisconsin

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 2, 2023. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.