Active NPI
Lisa Michelle Pace, PTA
- Physical Therapy Assistant
- Alton, IL
National Provider Identifier
1184916041
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 160.001959
- Practice address
- 1 Memorial Dr
Alton, IL 62002-6722 - Phone
- (618) 463-7429
- NPI assigned
- May 11, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 160.001959 | IL | Primary |
Addresses
Primary practice location
1 Memorial Dr
Alton, IL 62002-6722
Mailing address
840 E Ferguson Ave
Wood River, IL 62095-2150
Phone (618) 251-4369
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 160.001959 | IL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1305072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1305072000000",
"number": "1184916041",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "840 E FERGUSON AVE",
"city": "WOOD RIVER",
"state": "IL",
"postal_code": "620952150",
"telephone_number": "618-251-4369"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 MEMORIAL DR",
"city": "ALTON",
"state": "IL",
"postal_code": "620026722",
"telephone_number": "618-463-7429"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PACE",
"first_name": "LISA",
"middle_name": "MICHELLE",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-05-11",
"last_updated": "2011-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IL",
"license": "160.001959",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Alton, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.