Active NPI
Dawnine Marie Boldon, LPTA
- Physical Therapy Assistant
- Lake Mills, WI
National Provider Identifier
1851569628
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 966-019
- Practice address
- 200 E Tyranena Park Rd
Lake Mills, WI 53551-9678 - Phone
- (920) 648-8170
- Fax
- (920) 648-8225
- NPI assigned
- Feb 14, 2008
- 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 Therapy Assistant | 225200000X | 966-019 | WI | Primary |
Addresses
Primary practice location
200 E Tyranena Park Rd
Lake Mills, WI 53551-9678
Mailing address
200 E Tyranena Park Rd
Lake Mills, WI 53551-9678
Phone (920) 648-8170
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 36149300 | Medicaid | WI |
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 |
|---|---|---|---|
| 966-019 | WI | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1202947200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202947200000",
"number": "1851569628",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 E TYRANENA PARK RD",
"city": "LAKE MILLS",
"state": "WI",
"postal_code": "535519678",
"telephone_number": "920-648-8170",
"fax_number": "920-648-8225"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 E TYRANENA PARK RD",
"city": "LAKE MILLS",
"state": "WI",
"postal_code": "535519678",
"telephone_number": "920-648-8170",
"fax_number": "920-648-8225"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLDON",
"first_name": "DAWNINE",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "LPTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-02-14",
"last_updated": "2008-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "WI",
"license": "966-019",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "36149300",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Mills, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.