Active NPI
Courtney Eileen Johnson
- Pediatric Physical Therapist
- West Bend, WI
National Provider Identifier
1932213105
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- 10639
- Practice address
- 540 Shepherds Dr
West Bend, WI 53090-8488 - Phone
- (262) 306-8450
- NPI assigned
- Aug 18, 2006
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 10639 | WI | Primary |
Addresses
Primary practice location
540 Shepherds Dr
West Bend, WI 53090-8488
Mailing address
540 Shepherds Dr
West Bend, WI 53090-8488
Phone (262) 306-8450
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rehab Resources Inc | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155859200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1932213105",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "540 SHEPHERDS DR",
"city": "WEST BEND",
"state": "WI",
"postal_code": "530908488",
"telephone_number": "262-306-8450"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "540 SHEPHERDS DR",
"city": "WEST BEND",
"state": "WI",
"postal_code": "530908488",
"telephone_number": "262-306-8450"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "COURTNEY",
"middle_name": "EILEEN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "WI",
"license": "10639",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Bend, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.