Active NPI
Mark Lydecker
- Physical Therapist
- Wauwatosa, WI
National Provider Identifier
1669010963
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 8700 W Watertown Plank Rd
Wauwatosa, WI 53226-3595 - Phone
- (414) 805-8656
- NPI assigned
- Dec 17, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | WI | ||
| Physical Therapist | 225100000X | WI | Primary |
Addresses
Primary practice location
8700 W Watertown Plank Rd
Wauwatosa, WI 53226-3595
Mailing address
8700 W Watertown Plank Rd
Wauwatosa, WI 53226-3595
Phone (414) 805-8656
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1576540800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1576540800000",
"number": "1669010963",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8700 W WATERTOWN PLANK RD",
"city": "WAUWATOSA",
"state": "WI",
"postal_code": "532263595",
"telephone_number": "414-805-8656"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8700 W WATERTOWN PLANK RD",
"city": "WAUWATOSA",
"state": "WI",
"postal_code": "532263595",
"telephone_number": "414-805-8656"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LYDECKER",
"first_name": "MARK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-12-17",
"last_updated": "2019-12-17",
"certification_date": "2019-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "WI",
"license": null,
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wauwatosa, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 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.