LARA A BLECK (PT) – Physical Therapist, NPI 1114002623
Physical Therapist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,991 PHYSICAL THERAPIST IN PRIVATE PRACTICE in WI
Provider Addresses for LARA A BLECK (PT)
1640 N CASALOMA DR
APPLETON, WI 549138245
Phone: (920) 903-8545
Type: Location
Orthopedic & Sports Institute of the Fox Valley, 2105, East Enterprise Avenue, Appleton, Outagamie County, Wisconsin, 54913, United States
APPLETON, WI 549137862
Phone: (920) 991-2561
Fax: (920) 991-2563
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2004-09-11
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20040911000100 | I | Physical Therapist In Private Practice | WI | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 97110 | Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes | 125 | 11 | $0 |
| 97162 | Evaluation for physical therapy, typically 30 minutes | 11 | 11 | $0 |
Insurance plans in this area (ZIP 54913)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| PHYSICAL THERAPY | WI | 97110 | Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes | 245 | 18 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Physical Therapist In Private Practice | WI | |
| Physical Therapist In Private Practice | MN | |
| Physical Therapist In Private Practice | WI | |
| Physical Therapist In Private Practice | MI | |
| Physical Therapist In Private Practice | WI | |
| Occupational Therapist In Private Practice | WI | |
| - | WI | |
| - | WI | |
| Physical Therapist In Private Practice | MI | |
| Physical Therapist In Private Practice | WI |
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