Traci Johnson, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA21935 Issued in FL

Practice address

2000 Principal LN
Fort Walton Beach, FL 32547-6636

Phone

(850) 362-6495

NPI assigned

Dec 22, 2009

Last updated

Dec 22, 2009By the provider in NPPES

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": "1261440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1261440000000",
    "number": "1750610762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 PRINCIPAL LN",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476636",
            "telephone_number": "850-362-6495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 PRINCIPAL LN",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476636",
            "telephone_number": "850-362-6495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "TRACI",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-12-22",
        "last_updated": "2009-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "PTA21935",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew S Johnson, MD
• Melissa Sue Johnson, BASLPA
• Michael Andrew Johnson, PA-C
• Ronald F Johnson, MD
• Shaelyn La'Brea Johnson
• Emmalyn Claire Johnston
• Katrina Jones-Lewis
• Angelica Jones, OD
• Ciannah Janicia Jones
• Claire Jones

• Physical Therapy Assistant in Fort Walton Beach, FL
• Providers in Fort Walton Beach, FL by specialty
• Physical Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2009; 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.