Lois L Flock, PTA

Individual provider Active NPI Physical Therapy Assistant · Sparta, WI

NPI 1881964229 · NPPES record last updated Feb 6, 2015

Key facts

NPI
1881964229
Entity type
Individual (NPI type 1)
Primary specialty
Physical Therapy Assistant 225200000X
License
798-19 (WI)
Practice address
331 S Water St
Sparta, WI 54656-1726
Phone
(608) 366-6239
NPI assigned
Jan 3, 2012
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
798-19WIMDPhysical Therapy Assistant

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 798-19 WI Yes

Addresses

Primary practice location

331 S Water St
Sparta, WI 54656-1726

Mailing address

331 S Water St
Sparta, WI 54656-1726
Phone (608) 366-6239

Other identifiers

IdentifierTypeStateIssuer
225200000XOtherWIPRIVATE INSURANCE

Other providers in Sparta, WI

All providers in Sparta, WI · Physical Therapy Assistant in Wisconsin

Sources for this page

Verify at the official NPI Registry.