Active NPI
Tracy Johnson, PTA
- Physical Therapy Assistant
- Lake Village, AR
National Provider Identifier
1245067982
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2520
- Practice address
- 2729 S. Hwy 65 82
Null
Lake Village, AR 71653 - Phone
- (870) 265-9390
- NPI assigned
- Sep 17, 2024
- Sex
- Female
- 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 Therapy Assistant | 225200000X | 2520 | AR | Primary |
Addresses
Primary practice location
2729 S. Hwy 65 82
Null
Lake Village, AR 71653
Mailing address
2729 S. Hwy 65 82
Null
Lake Village, AR 71653
Phone (870) 265-9390
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1726531200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726531200000",
"number": "1245067982",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2729 S. HWY 65 82",
"address_2": "NULL",
"city": "LAKE VILLAGE",
"state": "AR",
"postal_code": "71653",
"telephone_number": "870-265-9390"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2729 S. HWY 65 82",
"address_2": "NULL",
"city": "LAKE VILLAGE",
"state": "AR",
"postal_code": "71653",
"telephone_number": "870-265-9390"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "TRACY",
"name_prefix": "Mrs.",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-09-17",
"last_updated": "2024-09-17",
"certification_date": "2024-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physical Therapy Assistant",
"state": "AR",
"license": "2520",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Village, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.