Active NPI
Keith Vincent Johnson, ATC, NRAEMT
- Athletic Trainer
- Malvern, PA
National Provider Identifier
1700929031
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- RT001618A
- Practice address
- 13 Fahnestock Rd
Malvern, PA 19355-2104 - Phone
- (610) 633-1478
- NPI assigned
- Feb 15, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | RT001618A | PA | Primary |
Addresses
Primary practice location
13 Fahnestock Rd
Malvern, PA 19355-2104
Mailing address
13 Fahnestock Rd
Malvern, PA 19355-2104
Phone (610) 633-1478
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RT001618A | PA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171497600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1450224000000",
"number": "1700929031",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13 FAHNESTOCK RD",
"city": "MALVERN",
"state": "PA",
"postal_code": "193552104",
"telephone_number": "610-633-1478"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13 FAHNESTOCK RD",
"city": "MALVERN",
"state": "PA",
"postal_code": "193552104",
"telephone_number": "610-633-1478"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "KEITH",
"middle_name": "VINCENT",
"name_prefix": "Mr.",
"credential": "ATC, NRAEMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-15",
"last_updated": "2015-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "PA",
"license": "RT001618A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Malvern, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.