Kenneth Clark Johnson, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

05005624A Issued in IN

Practice address

7855 S Emerson Ave
Suite W
Indianapolis, IN 46237-8668

Phone

(317) 581-1890

Fax

(317) 581-2436

NPI assigned

Jul 5, 2006

Sex

Male

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

Enrolled in IN

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Body One Health and Fitness Center, LLC

  • Physical Therapist
  • Indianapolis, IN
  • NPI 1528092442
  Medicare reassignment NPD

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414454400000",
    "number": "1952332322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8902 N MERIDIAN ST",
            "address_2": "STE 215",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462605382",
            "telephone_number": "317-581-1890",
            "fax_number": "317-581-2436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7855 S EMERSON AVE",
            "address_2": "SUITE W",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462378668",
            "telephone_number": "317-581-1890",
            "fax_number": "317-581-2436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KENNETH",
        "middle_name": "CLARK",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2014-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05005624A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaylee Johnson
• Kelly Johnson, RBT
• Kelly Denise Johnson, FNP-C
• Kelsey Johnson
• Kendra V Johnson, LCSW
• Khalilia Johnson
• Kim Johnson, MHR, D.MIN, CSAYC
• Kimberly Johnson, LMHCA
• Kimberly Diana Johnson, N.P.
• Kimberly E Johnson, PSYD, HSPP, APIT

• Physical Therapist in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Physical Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.