Active NPI
Lisa Lynn Widder, PTA, LMT
- Physical Therapy Assistant
- Madison, WI
National Provider Identifier
1912614686
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2260
- Practice address
- 5249 E Terrace Dr
Madison, WI 53718-8339 - Phone
- (608) 222-9777
- NPI assigned
- Nov 2, 2022
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 15749 | WI | |
| Physical Therapy Assistant | 225200000X | 2260 | WI | Primary |
Addresses
Primary practice location
5249 E Terrace Dr
Madison, WI 53718-8339
Mailing address
301 E Main St Apt 312
Waunakee, WI 53597-1481
Phone (815) 608-1577
Other practice location 1
301 E Main St Apt 312
Waunakee, WI 53597-1481
Phone (815) 608-1577
Other practice location 2
6808 University Ave Ste 100
Middleton, WI 53562-2779
Phone (785) 375-4366
Other practice location 3
4602 Eastpark Blvd
Madison, WI 53718-2002
Phone (608) 440-6400
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 |
|---|---|---|---|
| 15749 | WI | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1667347200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667347200000",
"number": "1912614686",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 E MAIN ST APT 312",
"city": "WAUNAKEE",
"state": "WI",
"postal_code": "535971481",
"telephone_number": "815-608-1577"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5249 E TERRACE DR",
"city": "MADISON",
"state": "WI",
"postal_code": "537188339",
"telephone_number": "608-222-9777"
}
],
"practiceLocations": [
{
"address_1": "301 E Main St Apt 312",
"address_purpose": "LOCATION",
"city": "Waunakee",
"state": "WI",
"postal_code": "535971481",
"country_code": "US",
"telephone_number": "815-608-1577",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "6808 University Ave Ste 100",
"address_purpose": "LOCATION",
"city": "Middleton",
"state": "WI",
"postal_code": "535622779",
"country_code": "US",
"telephone_number": "785-375-4366",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4602 Eastpark Blvd",
"address_purpose": "LOCATION",
"city": "Madison",
"state": "WI",
"postal_code": "537182002",
"country_code": "US",
"telephone_number": "608-440-6400",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WIDDER",
"first_name": "LISA",
"middle_name": "LYNN",
"credential": "PTA, LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-11-02",
"last_updated": "2022-11-02",
"certification_date": "2022-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WI",
"license": "15749",
"primary": false
},
{
"code": "225200000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physical Therapy Assistant",
"state": "WI",
"license": "2260",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madison, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.