Active NPI
Keri Bobo Johnson, PTA
- Physical Therapy Assistant
- Hallsville, TX
National Provider Identifier
1457907388
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 251E00000X
- Practice address
- 318 Shady LN
Hallsville, TX 75650-2248 - Phone
- (903) 926-8608
- NPI assigned
- Aug 15, 2019
- Sex
- Female
- Sole proprietor
- No
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 | 251E00000X | TX | Primary |
Addresses
Primary practice location
318 Shady LN
Hallsville, TX 75650-2248
Mailing address
318 Shady LN
Hallsville, TX 75650-2248
Phone (903) 926-8608
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598758302 | Medicaid | TX |
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 |
|---|---|---|---|
| 251E00000X | TX | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1565827200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565827200000",
"number": "1457907388",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "318 SHADY LN",
"city": "HALLSVILLE",
"state": "TX",
"postal_code": "756502248",
"telephone_number": "903-926-8608"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "318 SHADY LN",
"city": "HALLSVILLE",
"state": "TX",
"postal_code": "756502248",
"telephone_number": "903-926-8608"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "KERI",
"middle_name": "BOBO",
"name_prefix": "Mrs.",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-08-15",
"last_updated": "2019-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TX",
"license": "251E00000X",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1598758302",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hallsville, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.