Lisa T Martin, MPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

6029 Issued in MN

Practice address

110 Pleasant Ave S
Park Rapids, MN 56470-1415

Phone

(218) 237-3052

NPI assigned

Jun 22, 2010

Last updated

Sep 4, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1277164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567555200000",
    "number": "1376864603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1425 S COLUMBIA RD",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014039",
            "telephone_number": "701-746-8374",
            "fax_number": "701-780-0885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 PLEASANT AVE S",
            "city": "PARK RAPIDS",
            "state": "MN",
            "postal_code": "564701415",
            "telephone_number": "218-237-3052"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "829 Lake Ave Ste B",
            "address_purpose": "LOCATION",
            "city": "Detroit Lakes",
            "state": "MN",
            "postal_code": "565013017",
            "country_code": "US",
            "telephone_number": "218-237-3052",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "LISA",
        "middle_name": "T",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-22",
        "last_updated": "2019-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "6029",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1376864603",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michelle Malkowski
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• Richard Marquardt
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• Mary J McCarthy, APRN, CNP
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• Megan Meyers
• Michael L Vettel (The Pharmacy Shoppe)

• Physical Therapist in Park Rapids, MN
• Providers in Park Rapids, MN by specialty
• Physical Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2019; 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.