Lisa A Duckworth, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT04118 Issued in GA

Practice address

103 Maple Dr
Suite 8
Martinez, GA 30907-4283

Phone

(706) 364-5262

Fax

(706) 364-5263

NPI assigned

Nov 13, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ducktails Pediatric Therapy and Wellness Inc

  • Physical Therapy Clinic/Center
  • Evans, GA
  • NPI 1558477695
  NPD

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636588800000",
    "number": "1437220126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 UNIVERSITY PKWY",
            "address_2": "STE 100",
            "city": "AIKEN",
            "state": "SC",
            "postal_code": "298016810",
            "telephone_number": "803-293-1540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 MAPLE DR",
            "address_2": "SUITE 8",
            "city": "MARTINEZ",
            "state": "GA",
            "postal_code": "309074283",
            "telephone_number": "706-364-5262",
            "fax_number": "706-364-5263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUCKWORTH",
        "first_name": "LISA",
        "middle_name": "A",
        "credential": "P.T.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-13",
        "last_updated": "2021-11-11",
        "certification_date": "2021-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT04118",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000767456C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dr. William E. Goss,P.C.
• Shdonna Loraine Drumgoole
• Kelley Lyn Dube, RPH.
• Anna Katherine Wiggins Duckworth, M.D.
• Kimberly P Duckworth, RPH
• Sandra Jean Dunn Anderson, DC
• Heather Dutton
• Sara L Dyer, D.M.D
• Ec Martinez Operations, LLC
• Alice Renee Edwards-Yarima, CNA

• Physical Therapist in Martinez, GA
• Providers in Martinez, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2021; 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.