Active NPI
Lisa Karen Dodge
- Mechanotherapist
- Clear Lake, WI
National Provider Identifier
1245563196
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mechanotherapist
- License
- 3790-046
- Practice address
- 571 75TH St
Clear Lake, WI 54005-3819 - Phone
- (715) 268-9006
- NPI assigned
- Sep 10, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mechanotherapist | 172M00000X | 3790-046 | WI | Primary |
| Point of Service | 305S00000X | 3790-046 | WI |
Addresses
Primary practice location
571 75TH St
Clear Lake, WI 54005-3819
Mailing address
571 75TH St
Clear Lake, WI 54005-3819
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 |
|---|---|---|---|
| 3790-046 | WI | MD | Mechanotherapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1252540800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1252540800000",
"number": "1245563196",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "571 75TH ST",
"city": "CLEAR LAKE",
"state": "WI",
"postal_code": "540053819"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "571 75TH ST",
"city": "CLEAR LAKE",
"state": "WI",
"postal_code": "540053819",
"telephone_number": "715-268-9006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DODGE",
"first_name": "LISA",
"middle_name": "KAREN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-09-10",
"last_updated": "2009-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "172M00000X",
"taxonomy_group": "",
"desc": "Mechanotherapist",
"state": "WI",
"license": "3790-046",
"primary": true
},
{
"code": "305S00000X",
"taxonomy_group": "",
"desc": "Point of Service",
"state": "WI",
"license": "3790-046",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clear Lake, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.