Bergan Jayde Johnsen, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

110375 Issued in IA

Practice address

3000 Risen Son Blvd
Council Bluffs, IA 51503-1911

Phone

(712) 366-9655

NPI assigned

Sep 16, 2021

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1631750400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631750400000",
    "number": "1740950146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2396 SHARON AVE",
            "city": "LOGAN",
            "state": "IA",
            "postal_code": "515465028",
            "telephone_number": "712-592-3358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 RISEN SON BLVD",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515031911",
            "telephone_number": "712-366-9655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSEN",
        "first_name": "BERGAN",
        "middle_name": "JAYDE",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-16",
        "last_updated": "2021-09-16",
        "certification_date": "2021-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IA",
            "license": "110375",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julie Laura Jochum, O.D.
• Amanda Johanning
• John M. Ippolito MD, P.C
• Samantha Joylynn John, PTA
• Kevin C Johns, LPTA
• Teresa A Johnsen, CCC-SLP
• J Terry Johnson, DDS
• Jill Marie Johnson, LMHC, LMHP
• Lynette Johnson
• Molly Beth Johnson, APRN

• Physical Therapy Assistant in Council Bluffs, IA
• Providers in Council Bluffs, IA by specialty
• Physical Therapy Assistant in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2021; 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.