Individual
LISA KAREN DODGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
571 75TH ST, CLEAR LAKE, WI 54005-3819
(715) 268-9006
Mailing address
571 75TH ST, CLEAR LAKE, WI 54005-3819
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
3790-046
WI
305S00000X
Point of Service
3790-046
WI
Other
Enumeration date
09/10/2009
Last updated
09/10/2009
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