NPI 1245563196

Lisa Karen Dodge

Practitioner Mechanotherapist Clear Lake, WI

Practice location

Address: 571 75th St, Clear Lake, WI 54005-3819
Phone: (715) 268-9006

Registered specialties (2)

Mechanotherapist Primary

Other Service Providers Taxonomy 172M00000X Licence 3790-046 (WI)

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Point of Service

Managed Care Organizations Taxonomy 305S00000X Licence 3790-046 (WI)

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Registry record

NPI: 1245563196
Entity type: Individual
Sex (as registered): Female
NPI issued: 10 Sep 2009
Record last updated: 10 Sep 2009

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.