Active NPI
Sue Ellen Johnson
- Physical Therapy Assistant
- Soldiers Grove, WI
National Provider Identifier
1154698900
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 975-019
- Practice address
- 101 Sunshine Blvd
Soldiers Grove, WI 54655-7106 - Phone
- (608) 624-5127
- NPI assigned
- Nov 22, 2011
- Last updated
- Nov 22, 2011
- Sex
- Female
- Sole proprietor
- No
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 Therapy Assistant | 225200000X | 975-019 | WI | Primary |
Addresses
Primary practice location
101 Sunshine Blvd
Soldiers Grove, WI 54655-7106
Mailing address
27690 Ermine Ave
Tomah, WI 54660-7505
Phone (608) 372-3617
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 |
|---|---|---|---|
| 975-019 | WI | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1321920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321920000000",
"number": "1154698900",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "27690 ERMINE AVE",
"city": "TOMAH",
"state": "WI",
"postal_code": "546607505",
"telephone_number": "608-372-3617"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 SUNSHINE BLVD",
"city": "SOLDIERS GROVE",
"state": "WI",
"postal_code": "546557106",
"telephone_number": "608-624-5127"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "SUE",
"middle_name": "ELLEN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-11-22",
"last_updated": "2011-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "WI",
"license": "975-019",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Soldiers Grove, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 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.