Shannon Marie Johnson, PTA, BS

Key facts

NPI

1154844942

Entity type

Individual (NPI type 1)

Primary specialty

Physical Therapy Assistant 225200000X

License

06005493A (IN)

Practice address

2304 Dubois Dr
Warsaw, IN 46580-3213

Phone

(574) 267-3500

NPI assigned

Jul 24, 2017

Sex

Female

Sole proprietor

No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fort Wayne Orthopaedics, LLC Durable Medical Equipment & Medical Supplies · Gas City, IN · NPI 1699425082
  NPD (past)
• Peak Performance Orthopedic & Sports Physical Therapy, P.C. Physical Therapist · Warsaw, IN · NPI 1205900313
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Bachelor of Science

State licenses

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 24, 2017.

{
    "created_epoch": "1500854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1500854400000",
    "number": "1154844942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2304 DUBOIS DR",
            "city": "WARSAW",
            "state": "IN",
            "postal_code": "465803213",
            "telephone_number": "574-267-3500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2304 DUBOIS DR",
            "city": "WARSAW",
            "state": "IN",
            "postal_code": "465803213",
            "telephone_number": "574-267-3500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "SHANNON",
        "middle_name": "MARIE",
        "credential": "PTA, BS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-24",
        "last_updated": "2017-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IN",
            "license": "06005493A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Warsaw, IN

• Johnson Chiropractic, Inc
• Johnson Memorial Hospital
• Matthew G Johnson, DC
• Nathaniel Lee Johnson
• Rachel L Johnson, O.D.
• Carmen Johnston, PA
• John W Jones, DDS
• Karly Kristine Jones
• Rachel C Jones, FNP
• Stacey M Jones

All providers in Warsaw, IN · Physical Therapy Assistant in Indiana