Active NPI
Richard Wayne Johnson, PT, EDD
- Physical Therapist
- East Setauket, NY
National Provider Identifier
1073883575
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 005102-1
- Practice address
- 12 Technology Dr
East Setauket, NY 11733-4049 - Phone
- (631) 689-2009
- Fax
- (631) 689-2113
- NPI assigned
- Dec 31, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 005102-1 | NY | Primary |
Addresses
Primary practice location
12 Technology Dr
East Setauket, NY 11733-4049
Mailing address
12 Technology Dr
East Setauket, NY 11733-4049
Phone (631) 689-2009
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 |
|---|---|---|---|
| 005102-1 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1325289600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1325289600000",
"number": "1073883575",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12 TECHNOLOGY DR",
"city": "EAST SETAUKET",
"state": "NY",
"postal_code": "117334049",
"telephone_number": "631-689-2009",
"fax_number": "631-689-2113"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12 TECHNOLOGY DR",
"city": "EAST SETAUKET",
"state": "NY",
"postal_code": "117334049",
"telephone_number": "631-689-2009",
"fax_number": "631-689-2113"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "RICHARD",
"middle_name": "WAYNE",
"name_prefix": "Dr.",
"credential": "PT, EDD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-12-31",
"last_updated": "2011-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "005102-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Setauket, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.