Kalissa J Johnson, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

06002492A Issued in IN

Practice address

2121 Willow St
Vincennes, IN 47591-5355

Phone

(812) 882-1141

Fax

(812) 255-0045

NPI assigned

Sep 24, 2007

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

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": "1190592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190592000000",
    "number": "1376739318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7300 E INDIANA ST",
            "address_2": "SUITE 102",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477152794",
            "telephone_number": "812-476-0409",
            "fax_number": "812-476-1016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 WILLOW ST",
            "city": "VINCENNES",
            "state": "IN",
            "postal_code": "475915355",
            "telephone_number": "812-882-1141",
            "fax_number": "812-255-0045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KALISSA",
        "middle_name": "J",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-24",
        "last_updated": "2007-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IN",
            "license": "06002492A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamie Jenkins
• Anna Jenner, LSW
• Dennis Martin Jilka, MD
• Johnson Psychiatry
• Justin Sean Johnson, MD
• Kathryn Sue Joice, PTA
• Breanne Jones, RN, BSN
• Lucas Wade Jones, PA
• Samuel V Josephson, MD
• Alan Kaffenberger, PHARMD

• Physical Therapy Assistant in Vincennes, IN
• Providers in Vincennes, IN by specialty
• Physical Therapy Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2007; 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.