Active NPI
Melissa Jean Dyshaw, D.P.T.
- Physical Therapist
- New Richmond, WI
National Provider Identifier
1629360391
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 11659024
- Practice address
- 1127 W 8TH St
New Richmond, WI 54017-1467 - Phone
- (171) 524-6685
- Fax
- (171) 524-6763
- NPI assigned
- May 12, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 11659024 | WI | Primary |
Addresses
Primary practice location
1127 W 8TH St
New Richmond, WI 54017-1467
Mailing address
13770 44TH St N
Stillwater, MN 55082-1262
Phone (651) 895-5364
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11659024 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1305158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1386115200000",
"number": "1629360391",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13770 44TH ST N",
"city": "STILLWATER",
"state": "MN",
"postal_code": "550821262",
"telephone_number": "651-895-5364"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1127 W 8TH ST",
"city": "NEW RICHMOND",
"state": "WI",
"postal_code": "540171467",
"telephone_number": "171-524-6685",
"fax_number": "171-524-6763"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DYSHAW",
"first_name": "MELISSA",
"middle_name": "JEAN",
"credential": "D.P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-05-12",
"last_updated": "2013-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "11659024",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Richmond, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.