Active NPI
Nathan Johnson
- Physical Therapist
- Grand Haven, MI
National Provider Identifier
1609379494
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- P21310
- Practice address
- 15958 Winans St
Grand Haven, MI 49417-9636 - Phone
- (616) 607-4425
- NPI assigned
- Mar 17, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | |||
| Physical Therapist | 225100000X | P21310 | NC | Primary |
Addresses
Primary practice location
15958 Winans St
Grand Haven, MI 49417-9636
Mailing address
135 River Birch Grove Rd Apt 4
Asheville, NC 28806-0341
Phone (616) 607-4425
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 |
|---|---|---|---|
| P21310 | NC | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1521244800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655337600000",
"number": "1609379494",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "135 RIVER BIRCH GROVE RD APT 4",
"city": "ASHEVILLE",
"state": "NC",
"postal_code": "288060341",
"telephone_number": "616-607-4425"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15958 WINANS ST",
"city": "GRAND HAVEN",
"state": "MI",
"postal_code": "494179636",
"telephone_number": "616-607-4425"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "NATHAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-03-17",
"last_updated": "2022-06-16",
"certification_date": "2022-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": null,
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "P21310",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Haven, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 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.