Lisa Sue Nikodym, M.T.

Primary specialty

Massage TherapistTaxonomy code 225700000X

Practice address

225 N Benton Drive
Suite 105
Sauk Rapids, MN 56379-1597

Phone

(320) 252-2225

Fax

(320) 252-2159

NPI assigned

Jun 19, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Medical Technician

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

{
    "created_epoch": "1592524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592524800000",
    "number": "1518583111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 N BENTON DRIVE",
            "address_2": "SUITE 105",
            "city": "SAUK RAPIDS",
            "state": "MN",
            "postal_code": "563791597",
            "telephone_number": "320-252-2225",
            "fax_number": "320-252-2159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 N BENTON DRIVE",
            "address_2": "SUITE 105",
            "city": "SAUK RAPIDS",
            "state": "MN",
            "postal_code": "563791597",
            "telephone_number": "320-252-2225",
            "fax_number": "320-252-2159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIKODYM",
        "first_name": "LISA",
        "middle_name": "SUE",
        "credential": "M.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-19",
        "last_updated": "2020-06-19",
        "certification_date": "2020-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abdurahman Osman Mukhtar
• MW Minnetonka Operating LLC
• MW Sauk Rapids Operating, LLC
• Debra Nagel
• Amber Nichol Nelson
• Kenzie Koerner Norgart
• North Benton Dental Care
• Sumaya Mahad Nuur
• Khalid Odowa
• Aisha Omar

• Massage Therapist in Sauk Rapids, MN
• Providers in Sauk Rapids, MN by specialty
• Massage Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2020; 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.