Fred Kendall Johnson, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT25177 Issued in FL

Practice address

325 MDG 340 Magnolia Circle
Tyndall Afb, FL 32403

Phone

(850) 283-7019

NPI assigned

Oct 22, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Premier Physical Therapy Sport Medicine IncGroup PAC ID 3173413549, 37 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Networks

• Freedom Health HMO Network

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

• Premier Physical Therapy Sport Medicine Inc

  • Physical Therapist
  • Port St Lucie, FL
  • NPI 1649380064
  Medicare reassignment Care Compare group NPD
• Premier Physical Therapy & Sports Medicine

  • Physical Therapist
  • Jensen Beach, FL
  • NPI 1265724330
  NPD
• Premier Physical Therapy Sport Medicine Inc

  • Physical Therapist
  • Fort Pierce, FL
  • NPI 1265542682
  NPD
• Premier Physical Therapy Sport Medicine Inc

  • Physical Therapist
  • Port St Lucie, FL
  • NPI 1417067844
  NPD (past)
• Premier Physical Therapy and Wellness, PC

  • Physical Therapist
  • New York, NY
  • NPI 1821412495
  NPD (past)
• Premier Physical Therapy and Wellness, PC

  • Physical Therapist
  • New York, NY
  • NPI 1912996141
  NPD (past)

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

{
    "created_epoch": "1224633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626912000000",
    "number": "1689826554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "359 SE 7TH ST",
            "city": "DANIA BEACH",
            "state": "FL",
            "postal_code": "330044403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 MDG 340 MAGNOLIA CIRCLE",
            "city": "TYNDALL AFB",
            "state": "FL",
            "postal_code": "32403",
            "telephone_number": "850-283-7019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "FRED",
        "middle_name": "KENDALL",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-10-22",
        "last_updated": "2021-07-22",
        "certification_date": "2021-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "029708",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT25177",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark Lee Harris II, DDS
• Teresa Harroun, RN
• John Randall Heil, M.D.
• Matthew Hetrick, IDMT
• Brittany Lynn Holm, OD
• Kimberly Susan Johnson, M.D.
• Jonathon Edward Josephson, MD
• Robert Sebastian Kent, M.D.
• Christine Kersten
• Eric James Kirwan, LISW

• Physical Therapist in Tyndall Afb, FL
• Providers in Tyndall Afb, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2021; 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.