Wayne A Johansen, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

987 Issued in WI

Practice address

626 14TH St
Baraboo, WI 53913-1535

Phone

(608) 356-2334

Fax

(608) 356-2636

NPI assigned

Sep 21, 2005

Last updated

Jul 9, 2007By 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 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Wayne a Johansen

  dba Physical Therapy Services

  • Physical Therapy Clinic/Center
  • Baraboo, WI
  • NPI 1356564520
  NPD (past) Authorized official
• New Life Physical Therapy & Sports Medicine Baraboo, LLC

  • Physical Therapist
  • Baraboo, WI
  • NPI 1154599082
  NPD (past)

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

{
    "created_epoch": "1127260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1629064126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31",
            "city": "BARABOO",
            "state": "WI",
            "postal_code": "539130031",
            "telephone_number": "608-356-2334",
            "fax_number": "608-356-2636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "626 14TH ST",
            "city": "BARABOO",
            "state": "WI",
            "postal_code": "539131535",
            "telephone_number": "608-356-2334",
            "fax_number": "608-356-2636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHANSEN",
        "first_name": "WAYNE",
        "middle_name": "A",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-21",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "987",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40414400",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40119700",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS",
            "identifier": "W006005",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITY HEALTH INSUR",
            "identifier": "39-1598907-01",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIANS PLUS INS CORP",
            "identifier": "1028602",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Allie Isaacson, RN
• Jay Samuel Jackson, DO
• Colleen S James, LCSW, LPC, SAC
• Lisa Lynn James, RN
• David Lloyd Jarvis, M.D.
• Chad A Johnson, OD
• Elizabeth Tweeten Johnson, RN, BSN
• Robert W Johnson
• Kellie S Jones-Monahan, M.D.
• Jerry Ray Jones

• Physical Therapist in Baraboo, WI
• Providers in Baraboo, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.