Douglas Brent Johnson, R.P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT14568 Issued in CA

Practice address

3440 S Higuera St
Suite 120
San Luis Obispo, CA 93401-7393

Phone

(805) 439-2159

Fax

(805) 439-2160

NPI assigned

Jul 19, 2006

Last updated

Sep 7, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sports & Wellness Physical Therapy, Inc.

  • Physical Therapist
  • San Luis Obispo, CA
  • NPI 1639195761
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473206400000",
    "number": "1609895432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3070",
            "city": "SHELL BEACH",
            "state": "CA",
            "postal_code": "934483070",
            "telephone_number": "805-439-2159",
            "fax_number": "805-439-2160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3440 S HIGUERA ST",
            "address_2": "SUITE 120",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934017393",
            "telephone_number": "805-439-2159",
            "fax_number": "805-439-2160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "DOUGLAS",
        "middle_name": "BRENT",
        "credential": "R.P.T.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2016-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT14568",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PT0145680",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Camille Johnson, LMFT
• Carl E Johnson, M.D.
• Christopher Johnson
• Christopher Warren Johnson, MD
• Dean Johnson
• Hailey Johnson
• Jessica L Johnson, PA-C
• Kelsey R Johnson
• Kimberly D Johnson, O.D.
• Madeline L Johnson

• Physical Therapist in San Luis Obispo, CA
• Providers in San Luis Obispo, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.