Active NPI
Lisa Bracht, MBA, LAT, ATC
- Athletic Trainer
- Fort Wayne, IN
National Provider Identifier
1780197301
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 36002654A
- Practice address
- 3601 S Calhoun St
Fort Wayne, IN 46807-2006 - Phone
- (260) 467-2653
- NPI assigned
- Nov 6, 2017
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 36002654A | IN | Primary |
Addresses
Primary practice location
3601 S Calhoun St
Fort Wayne, IN 46807-2006
Mailing address
1518 Tecumseh St
Fort Wayne, IN 46805-4248
Phone (260) 409-8862
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
- Credentials
- Master of Business Administration
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36002654A | IN | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1509926400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1509926400000",
"number": "1780197301",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1518 TECUMSEH ST",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468054248",
"telephone_number": "260-409-8862"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3601 S CALHOUN ST",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468072006",
"telephone_number": "260-467-2653"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRACHT",
"first_name": "LISA",
"credential": "MBA, LAT, ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-11-06",
"last_updated": "2017-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IN",
"license": "36002654A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.