Brent Johnson, PTA
Individual provider Active NPI Contractor · Chesapeake, VA
NPI 1306233283 · NPPES record last updated Jan 28, 2016
Key facts
- NPI
- 1306233283
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- PTA 23821 (FL)
- Practice address
- 404 Cayland CT
Chesapeake, VA 23322-3624 - Phone
- (757) 482-4013
- NPI assigned
- Apr 18, 2015
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA 23821 | FL | MD | Contractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Harmony Home Care | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | PTA 23821 | FL | Yes |
Addresses
Primary practice location
404 Cayland CT
Chesapeake, VA 23322-3624
Mailing address
404 Cayland CT
Chesapeake, VA 23322-3624
Phone (757) 482-4013
Other providers in Chesapeake, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 28, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.