John J Johnsen, LAT

Key facts

NPI

1174512461

Entity type

Individual (NPI type 1)

Primary specialty

Athletic Trainer 2255A2300X

License

4939 (WI)

Practice address

800 Algoma Blvd
Oshkosh, WI 54901-3551

Phone

(920) 424-3225

NPI assigned

Oct 19, 2005

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 13, 2026.

{
    "created_epoch": "1129680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1174512461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1570 MIDWAY PL",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "549521165",
            "telephone_number": "920-720-1784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 ALGOMA BLVD",
            "city": "OSHKOSH",
            "state": "WI",
            "postal_code": "549013551",
            "telephone_number": "920-424-3225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSEN",
        "first_name": "JOHN",
        "middle_name": "J",
        "credential": "LAT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-19",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "WI",
            "license": "4939",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Oshkosh, WI · Athletic Trainer in Wisconsin