Active NPI
Marc Johnson, PTA
- Physical Therapy Assistant
- Wyncote, PA
National Provider Identifier
1487038592
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- TE010712
- Practice address
- 1245 Church Rd
Wyncote, PA 19095-1800 - Phone
- (215) 884-9990
- NPI assigned
- Jul 17, 2015
- 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 | TE010712 | PA | Primary |
Addresses
Primary practice location
1245 Church Rd
Wyncote, PA 19095-1800
Mailing address
248 N Spring Garden St
Ambler, PA 19002-4220
Phone (215) 380-1073
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 |
|---|---|---|---|
| TE010712 | PA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1437091200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1437091200000",
"number": "1487038592",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "248 N SPRING GARDEN ST",
"city": "AMBLER",
"state": "PA",
"postal_code": "190024220",
"telephone_number": "215-380-1073"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1245 CHURCH RD",
"city": "WYNCOTE",
"state": "PA",
"postal_code": "190951800",
"telephone_number": "215-884-9990"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "MARC",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-07-17",
"last_updated": "2015-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "PA",
"license": "TE010712",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wyncote, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.