Lisa L Johnson, P.T.A.

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

378 Issued in WI

Practice address

1190 E Paradise Dr
West Bend, WI 53095-5444

Phone

(262) 306-6319

Fax

(262) 306-2964

NPI assigned

Feb 18, 2010

Last updated

Feb 19, 2010By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1266451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266537600000",
    "number": "1245552298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 W PARADISE DR",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530959795",
            "telephone_number": "262-306-6319",
            "fax_number": "262-306-2964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1190 E PARADISE DR",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530955444",
            "telephone_number": "262-306-6319",
            "fax_number": "262-306-2964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "LISA",
        "middle_name": "L",
        "credential": "P.T.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-02-18",
        "last_updated": "2010-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WI",
            "license": "378",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "378-19",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katie Ann Jensen, M.A./CFY-SLP
• Keyonta Latrise Johnson- Sims
• Bradley Zenor Johnson, DPT
• Courtney Eileen Johnson
• Jennifer Sue Johnson, LPC
• Mary Johnson, PT
• Matthew Johnson, LPC, SAC-IT
• Shannon Johnson
• Stefanie Johnson, LPC
• Tracy L Johnson

• Physical Therapy Assistant in West Bend, WI
• Providers in West Bend, WI by specialty
• Physical Therapy Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2010; 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.