Krista Lodge, DPT
Individual provider Active NPI Physical Therapist · Waterloo, IA
NPI 1346595667 · NPPES record last updated Feb 18, 2019
Key facts
- NPI
- 1346595667
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 12010-24 (WI)
- Practice address
- 1111 Ansborough Ave
Waterloo, IA 50701-2248 - Phone
- (319) 433-0130
- Fax
- (319) 433-0131
- NPI assigned
- Jul 24, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12010-24 | WI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Athletico LTD | Physical Therapist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 12010-24 | WI | Yes |
Addresses
Primary practice location
1111 Ansborough Ave
Waterloo, IA 50701-2248
Mailing address
600 Oakmont LN Ste 600C
Westmont, IL 60559-5548
Phone (630) 575-6200
Other names
- Krista Wills
Other providers in Waterloo, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 18, 2019. 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.