Active NPI
Marc Johnson
- Physical Therapy Assistant
- Colorado Springs, CO
National Provider Identifier
1336489533
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 12487
- Practice address
- 4885 Bittercreek Dr
Colorado Springs, CO 80922-2918 - Phone
- (417) 496-8907
- NPI assigned
- Feb 25, 2013
- Sex
- Male
- 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 | 12487 | CO | Primary |
Addresses
Primary practice location
4885 Bittercreek Dr
Colorado Springs, CO 80922-2918
Mailing address
4885 Bittercreek Dr
Colorado Springs, CO 80922-2918
Phone (417) 496-8907
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12487 | CO | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1361750400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1361750400000",
"number": "1336489533",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4885 BITTERCREEK DR",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809222918",
"telephone_number": "417-496-8907"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4885 BITTERCREEK DR",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809222918",
"telephone_number": "417-496-8907"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "MARC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-02-25",
"last_updated": "2013-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "CO",
"license": "12487",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Colorado Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.