Jennifer Johnson, PTA
Individual provider Active NPI Physical Therapy Assistant · Sparta, WI
NPI 1669929279 · NPPES record last updated Sep 1, 2016
Key facts
- NPI
- 1669929279
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 2456-19 (WI)
- Practice address
- 14345 County Hwy B
Sparta, WI 54656 - Phone
- (608) 526-9888
- NPI assigned
- Sep 1, 2016
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2456-19 | WI | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 2456-19 | WI | Yes |
Addresses
Primary practice location
14345 County Hwy B
Sparta, WI 54656
Mailing address
106 S Holmen Dr. Suite 2
Holmen, WI 54636
Other providers in Sparta, WI
- Innovations Rehabilitation, SC
- Leah Jenkins
- Emily Jerome
- Alicia Johnson
- Jenna Johnson
- Jessalyn Ilene Johnson
- Amanda K Kalisz
- Ethan Karls
- Megan Karls
- Myrna M Kasten
All providers in Sparta, WI · Physical Therapy Assistant in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 1, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.