NPIMap

Organization Active NPI

Jerry M Johnson Etal PTR Four Seasons Physical Therapy

Doing business as Four Seasons Physical Therapy

  • Physical Therapy Clinic/Center
  • Spokane, WA
National Provider Identifier
1245214543
Registry record updated Dec 31, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
601871376 Issued in WA
Legal business name
JERRY M JOHNSON ETAL PTR FOUR SEASONS PHYSICAL THERAPY
Doing business as
Four Seasons Physical Therapy
Practice address
1111 W Wellesley Ave
Spokane, WA 99205-1274
Phone
(509) 327-1578
Fax
(509) 327-1596
NPI assigned
Dec 1, 2005
Last updated
Dec 31, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Jerry Michael Johnson, PTNPI 1982688529
Title
Administrative Director
Phone
(509) 327-1578

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 601871376 WA Primary

Addresses

Primary practice location

1111 W Wellesley Ave
Spokane, WA 99205-1274

Mailing address

1111 W Wellesley Ave
Spokane, WA 99205-1274
Phone (509) 327-1578

Other identifiers 1

IdentifierTypeStateIssuer
7116312MedicaidWA

Other names 1

  • Four Seasons Physical Therapy Doing business as

National Provider Directory

National Provider Directory

Locations

1111 W Wellesley Ave
Spokane, WA 99205
Phone (509) 327-1578

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1356912000000",
    "number": "1245214543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 W WELLESLEY AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992051274",
            "telephone_number": "509-327-1578",
            "fax_number": "509-327-1596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 W WELLESLEY AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992051274",
            "telephone_number": "509-327-1578",
            "fax_number": "509-327-1596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERRY M JOHNSON ETAL PTR FOUR SEASONS PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-01",
        "last_updated": "2012-12-31",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "ADMINISTRATIVE DIRECTOR",
        "authorized_official_telephone_number": "509-327-1578",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "WA",
            "license": "601871376",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7116312",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Four Seasons Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Spokane, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.