Active NPI
Alyssa Lake
- Physical Therapy Assistant
- Ogallala, NE
National Provider Identifier
1235471673
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 1155
- Practice address
- 1720 N Spruce St
Ogallala, NE 69153-3307 - Phone
- (308) 284-4068
- NPI assigned
- Mar 25, 2013
- Last updated
- Mar 25, 2013
- 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 | 1155 | NE | Primary |
Addresses
Primary practice location
1720 N Spruce St
Ogallala, NE 69153-3307
Mailing address
1825 Road East 120
Paxton, NE 69155-3713
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 |
|---|---|---|---|
| 1155 | NE | MD | Dermatopathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1364169600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1364169600000",
"number": "1235471673",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1825 ROAD EAST 120",
"city": "PAXTON",
"state": "NE",
"postal_code": "691553713"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1720 N SPRUCE ST",
"city": "OGALLALA",
"state": "NE",
"postal_code": "691533307",
"telephone_number": "308-284-4068"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAKE",
"first_name": "ALYSSA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-03-25",
"last_updated": "2013-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "NE",
"license": "1155",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ogallala, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.