Individual provider Active NPI

Jason Johnson, PTA

  • Physical Therapy Assistant
  • Kingsport, TN
National Provider Identifier
1902358724
Registry record updated Oct 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
5187 Issued in TN
Practice address
2300 Pavilion Dr
Kingsport, TN 37660-4622
Phone
(423) 765-9655
NPI assigned
Oct 27, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 27, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 5187 TN Primary

Addresses

Primary practice location

2300 Pavilion Dr
Kingsport, TN 37660-4622

Mailing address

303 Shelby Ave
Church Hill, TN 37642-3156
Phone (423) 863-2418

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": "1477526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477526400000",
    "number": "1902358724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 SHELBY AVE",
            "city": "CHURCH HILL",
            "state": "TN",
            "postal_code": "376423156",
            "telephone_number": "423-863-2418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 PAVILION DR",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376604622",
            "telephone_number": "423-765-9655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JASON",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-10-27",
        "last_updated": "2016-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TN",
            "license": "5187",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingsport, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2016; 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.