James Eugene Johnson, PHYSICAL THERAPIST

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070.002597 Issued in IL

Practice address

409 NW 9TH Ave
Aledo, IL 61231-1258

Phone

(309) 582-5301

Fax

(309) 582-3737

NPI assigned

Sep 11, 2012

Last updated

Sep 11, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1347321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347321600000",
    "number": "1639429350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 NW 9TH AVE",
            "address_2": "MERCER COUNTY HOSPITAL",
            "city": "ALEDO",
            "state": "IL",
            "postal_code": "612311258",
            "telephone_number": "309-582-5301",
            "fax_number": "309-582-3737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 NW 9TH AVE",
            "city": "ALEDO",
            "state": "IL",
            "postal_code": "612311258",
            "telephone_number": "309-582-5301",
            "fax_number": "309-582-3737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JAMES",
        "middle_name": "EUGENE",
        "name_prefix": "Mr.",
        "credential": "PHYSICAL THERAPIST",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-09-11",
        "last_updated": "2012-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070.002597",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "366007544401",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "366007544001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Aledo, IL
• Providers in Aledo, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2012; 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.