Trevor Allen Johnson, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

038434 Issued in NY

Practice address

39 West Main Street
Canton, NY 13617

Phone

(315) 379-4700

Fax

(315) 713-6512

NPI assigned

May 21, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1432166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666051200000",
    "number": "1568841609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214 KING STREET",
            "city": "OGDENSBURG",
            "state": "NY",
            "postal_code": "13669",
            "telephone_number": "315-713-5660",
            "fax_number": "315-393-0055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 WEST MAIN STREET",
            "city": "CANTON",
            "state": "NY",
            "postal_code": "13617",
            "telephone_number": "315-379-4700",
            "fax_number": "315-713-6512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "TREVOR",
        "middle_name": "ALLEN",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-21",
        "last_updated": "2022-10-18",
        "certification_date": "2022-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305209173",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1256837",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "038434",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07254337",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sara Hutcheson, LCSWR
• Wendy Marie Jacobs, PT
• Adam David Jaffe
• Ralph M Johns, PSYD
• Renae Lynn Johnson, RN
• Eyal Kedar, M.D.
• Kristina Beth Kelly-Snow, MS IN MENTAL HEALTH
• Pamela Jane Kempshepherd, SLP
• Deborah Ann Kent, RN
• Alison Kern, CD

• Physical Therapist in Canton, NY
• Providers in Canton, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2022; 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.