Active NPI
Madison Edith Lodge, PT, DPT, CLT
- Physical Therapist
- Bath, NY
National Provider Identifier
1821872318
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 049810-01
- Practice address
- 7571 State Route 54
Bath, NY 14810-9504 - Phone
- (607) 776-8880
- NPI assigned
- Aug 24, 2023
- 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 | 049810-01 | NY | Primary |
Addresses
Primary practice location
7571 State Route 54
Bath, NY 14810-9504
Mailing address
5857 County Road 14
Alpine, NY 14805-9517
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 |
|---|---|---|---|
| 049810-01 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1692835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692835200000",
"number": "1821872318",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5857 COUNTY ROAD 14",
"city": "ALPINE",
"state": "NY",
"postal_code": "148059517"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7571 STATE ROUTE 54",
"city": "BATH",
"state": "NY",
"postal_code": "148109504",
"telephone_number": "607-776-8880"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LODGE",
"first_name": "MADISON",
"middle_name": "EDITH",
"credential": "PT, DPT, CLT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-08-24",
"last_updated": "2023-08-24",
"certification_date": "2023-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "049810-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bath, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.