Wendy E Johnson, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT3169 Issued in ID

Practice address

2170 W Ironwood Center Dr Ste B
Coeur D Alene, ID 83814-2606

Phone

(208) 667-1988

Fax

(208) 765-5654

NPI assigned

Aug 24, 2010

Last updated

Jul 21, 2022By 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 2

Addresses

Other names 1

• Wendy Bacon-Fulkerson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Advanced Physical Therapy Inc

  • Physical Therapist
  • Anchorage, AK
  • NPI 1437214459
  NPD (past)

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

{
    "created_epoch": "1282608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1932415254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3482",
            "city": "POST FALLS",
            "state": "ID",
            "postal_code": "838773482",
            "telephone_number": "208-209-6170",
            "fax_number": "208-209-6169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2170 W IRONWOOD CENTER DR STE B",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142606",
            "telephone_number": "208-667-1988",
            "fax_number": "208-765-5654"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8238 N Government Way",
            "address_purpose": "LOCATION",
            "city": "Hayden",
            "state": "ID",
            "postal_code": "838355034",
            "country_code": "US",
            "telephone_number": "208-762-2100",
            "fax_number": "208-762-2101",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12615 E Mission Ave Ste 109",
            "address_purpose": "LOCATION",
            "city": "Spokane Valley",
            "state": "WA",
            "postal_code": "992161047",
            "country_code": "US",
            "telephone_number": "509-891-2623",
            "fax_number": "509-891-2624",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "WENDY",
        "middle_name": "E",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-24",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT60387980",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT3169",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "WENDY",
            "last_name": "BACON-FULKERSON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Robert John Johnson, O.D.
• Simone Johnson, LMSW
• Tyler W Johnson, DO
• Vallenthia Ann Johnson, LMSW
• Wayne Clair Johnson
• Rosalie Nadine Johnston, LCPC
• Jonathan S King MD PC
• Kristina Marie Jones-Tarr, LMSW
• Brooke Jones
• Christopher Jones, PEER SUPPORT

• Physical Therapist in Coeur d'Alene, ID
• Providers in Coeur d'Alene, ID by specialty
• Physical Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.