Gilissa Johnson

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2305213488 Issued in VA

Practice address

12825 Minnieville Rd
Lake Ridge, VA 22192-3601

Phone

(703) 971-3701

NPI assigned

Feb 13, 2019

Last updated

Mar 16, 2023By 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)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Virginia Luna Care Physical Therapy LLC

  • Physical Therapist
  • Fairfax, VA
  • NPI 1235720848
  NPD

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

{
    "created_epoch": "1550016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678924800000",
    "number": "1346706546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20410 CENTURY BLVD STE 215",
            "city": "GERMANTOWN",
            "state": "MD",
            "postal_code": "208741187",
            "telephone_number": "240-731-9641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12825 MINNIEVILLE RD",
            "city": "LAKE RIDGE",
            "state": "VA",
            "postal_code": "221923601",
            "telephone_number": "703-971-3701"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "35095 US 19 N Ste 101",
            "address_purpose": "LOCATION",
            "city": "Palm Harbor",
            "state": "FL",
            "postal_code": "346841968",
            "country_code": "US",
            "telephone_number": "727-475-5540",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "GILISSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-13",
        "last_updated": "2023-03-16",
        "certification_date": "2023-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305213488",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PT LICENSE",
            "identifier": "PT34397",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Leslianne Grendysz, LNP
• Kristine Caroline Guerrero
• Courtney Hall
• Meredith Hill, RDN
• Ramin Ipakchi, MD
• Jennifer Johnson
• Rachita Kenny, CNS
• Riken Kumar, MD
• Lawrence R. Muller, DDS, PC
• Alison L Liudahl, AU.D.,C.C.C.-A,F.A.A

• Physical Therapist in Lake Ridge, VA
• Providers in Lake Ridge, VA by specialty
• Physical Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2023; 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.