NPIMap

Organization Active NPI

Lake Isabella Physical Therapy, LLC

  • Physical Therapy Clinic/Center
  • Weidman, MI
National Provider Identifier
1376811729
Registry record updated Dec 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
5501014675 Issued in MI
Legal business name
LAKE ISABELLA PHYSICAL THERAPY, LLC
Practice address
50 N Coldwater Rd
Suite D
Weidman, MI 48893-8845
Phone
(989) 546-7490
Fax
(989) 546-7298
NPI assigned
Dec 13, 2011
Last updated
Dec 15, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Shanon Marie Dexter, PT, DPT
Title
Owner, Physical Therapist
Phone
(989) 546-7490

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 5501014675 MI Primary

Addresses

Primary practice location

50 N Coldwater Rd
Suite D
Weidman, MI 48893-8845

Mailing address

50 N Coldwater Rd
Suite D
Weidman, MI 48893-8845
Phone (989) 546-7490

Other identifiers 2

IdentifierTypeStateIssuer
5501014675OtherMISTATE LICENSE
1598084667OtherMINPI TYPE I

National Provider Directory

National Provider Directory

Locations

50 N Coldwater Rd
Ste D
Weidman, MI 48893
Phone (989) 546-7490

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1323734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323907200000",
    "number": "1376811729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 N COLDWATER RD",
            "address_2": "SUITE D",
            "city": "WEIDMAN",
            "state": "MI",
            "postal_code": "488938845",
            "telephone_number": "989-546-7490",
            "fax_number": "989-546-7298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 N COLDWATER RD",
            "address_2": "SUITE D",
            "city": "WEIDMAN",
            "state": "MI",
            "postal_code": "488938845",
            "telephone_number": "989-546-7490",
            "fax_number": "989-546-7298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE ISABELLA PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-13",
        "last_updated": "2011-12-15",
        "status": "A",
        "authorized_official_last_name": "DEXTER",
        "authorized_official_first_name": "SHANON",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER, PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "989-546-7490",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MI",
            "license": "5501014675",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "5501014675",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI TYPE I",
            "identifier": "1598084667",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Weidman, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 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.

Verify at the official NPI Registry.