Lake Isabella Physical Therapy, LLC

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

5502001683 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

Aug 8, 2014

Last updated

Aug 8, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Shannon Marie Dexter, PT, DPT

Title

President, PT, DPT

Phone

(989) 546-7490

Specialties & licenses 3

Addresses

Other identifiers 2

Practitioners 4

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.

• Kelly Bechtel, PTA

  • Physical Therapy Assistant
  • Weidman, MI
  • NPI 1487994687
  NPD (past)
• Jennifer Morey Rau

  • Massage Therapist
  • Weidman, MI
  • NPI 1245674407
  NPD (past)
• Shannon Marie Roskamp, PT, DPT, MSA

  • Physical Therapist
  • Stanton, MI
  • NPI 1598084667
  NPD (past)
• Patricia Vondoloski

  • Massage Therapist
  • Weidman, MI
  • NPI 1790128122
  NPD (past)

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

{
    "created_epoch": "1407456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407456000000",
    "number": "1376952853",
    "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": "2014-08-08",
        "last_updated": "2014-08-08",
        "status": "A",
        "authorized_official_last_name": "DEXTER",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PRESIDENT, PT, DPT",
        "authorized_official_telephone_number": "989-546-7490",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501014675",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MI",
            "license": "5502003378",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MI",
            "license": "5502001683",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "UNVLIPT2011",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN MI5338",
            "identifier": "1376811729",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Henry P. Szelag, D.O., P.C.
• Hopewell Ranch
• Timothy Hutchins
• Alexandra Rae Kreger
• Lake Isabella Physical Therapy, LLC
• Destiny Antonia Lake
• Justin Linda
• Cheryl Lovett, MS
• Angela McNally, LPC
• Jennifer Morey Rau

• Physical Therapy Assistant in Weidman, MI
• Providers in Weidman, MI by specialty
• Physical Therapy Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2014; 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.