Active NPI
Mia Johnson
- Kinesiotherapist
- Tracy, CA
National Provider Identifier
1730729344
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Kinesiotherapist
- Practice address
- 17880 W Schulte Rd
Tracy, CA 95377-8909 - Phone
- (209) 221-6200
- NPI assigned
- Jan 11, 2020
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Kinesiotherapist | 226300000X | Primary |
Addresses
Primary practice location
17880 W Schulte Rd
Tracy, CA 95377-8909
Mailing address
3811 Lanyard Dr
Stockton, CA 95206-4958
Phone (209) 594-9977
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1578700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578700800000",
"number": "1730729344",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3811 LANYARD DR",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952064958",
"telephone_number": "209-594-9977"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17880 W SCHULTE RD",
"city": "TRACY",
"state": "CA",
"postal_code": "953778909",
"telephone_number": "209-221-6200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "MIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-01-11",
"last_updated": "2020-01-11",
"certification_date": "2020-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "226300000X",
"taxonomy_group": "",
"desc": "Kinesiotherapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tracy, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.