Sage Stout Johannessen, DPT

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

2305212499 Issued in VA

Practice address

3040 Berkmar Dr Ste A1
Charlottesville, VA 22901-1593

Phone

(434) 979-8628

NPI assigned

Nov 30, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Sage Amber Stout Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Susy Russell Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Charlottesville, VA
  • NPI 1902161672
  NPD
• The Charleston Center, Inc

  • Rehabilitation Clinic/Center
  • Charlottesville, VA
  • NPI 1427150630

  Physical Therapist

  NPD

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

{
    "created_epoch": "1669766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762300800000",
    "number": "1730899881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1618 CAMBRIDGE CIR",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229031316",
            "telephone_number": "802-922-0753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3040 BERKMAR DR STE A1",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229011593",
            "telephone_number": "434-979-8628"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 W 12th St Ste A1-100",
            "address_purpose": "LOCATION",
            "city": "Waynesboro",
            "state": "VA",
            "postal_code": "229804771",
            "country_code": "US",
            "telephone_number": "540-941-5501",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHANNESSEN",
        "first_name": "SAGE",
        "middle_name": "STOUT",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-30",
        "last_updated": "2025-11-05",
        "certification_date": "2025-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "VA",
            "license": "2305212499",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAGE",
            "last_name": "STOUT",
            "middle_name": "AMBER",
            "credential": "DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Miao Jiang, AG-ACNP
• Ann Marie Jinks, CRNA
• JMV Enterprises
• Jasmin Jo, M.D.
• Jody Forman, MSW, L.Ac., PLLC
• Jay A Johannigman, MD
• John H. Knight, Jr. DDS & Associates
• Jainy John, CRNA
• Dearing W. Johns, M.D.
• Carolyn Elizabeth Johnson, PSY.D.

• Physical Therapy Clinic/Center in Charlottesville, VA
• Providers in Charlottesville, VA by specialty
• Physical Therapy Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2025; 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.