NPIMap

Organization Active NPI

Wayne a Johansen

Doing business as Physical Therapy Services

  • Physical Therapy Clinic/Center
  • Baraboo, WI
National Provider Identifier
1356564520
Registry record updated Jun 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
987 Issued in WI
Legal business name
WAYNE A JOHANSEN
Doing business as
Physical Therapy Services
Practice address
626 14TH St
Baraboo, WI 53913-1535
Phone
(608) 356-2334
Fax
(608) 356-2636
NPI assigned
Apr 10, 2007
Last updated
Jun 17, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2008

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

Authorized official

Name
Mr. Wayne A JohansenNPI 1629064126
Title
Owner/Physical Therapist
Phone
(608) 356-2334

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 987 WI Primary

Addresses

Primary practice location

626 14TH St
Baraboo, WI 53913-1535

Mailing address

PO Box 31
Baraboo, WI 53913-0031
Phone (608) 356-2334

Other identifiers 1

IdentifierTypeStateIssuer
40414400MedicaidWI

Other names 1

  • PHYSICAL THERAPY SERVICES Doing business as

National Provider Directory

National Provider Directory

Locations

626 14th St
Baraboo, WI 53913
Phone (608) 356-2334

Practitioners & affiliated clinicians

Practitioners 5

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": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1356564520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31",
            "city": "BARABOO",
            "state": "WI",
            "postal_code": "539130031",
            "telephone_number": "608-356-2334",
            "fax_number": "608-356-2636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "626 14TH ST",
            "city": "BARABOO",
            "state": "WI",
            "postal_code": "539131535",
            "telephone_number": "608-356-2334",
            "fax_number": "608-356-2636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAYNE A JOHANSEN",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2008-06-17",
        "status": "A",
        "authorized_official_last_name": "JOHANSEN",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "608-356-2334",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "WI",
            "license": "987",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40414400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHYSICAL THERAPY SERVICES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Baraboo, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; 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.