Active NPI
Beverly Jane Johnson, PT
- Physical Therapist
- Grand Forks, ND
National Provider Identifier
1982807020
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 312
- Practice address
- 1000 South Columbia Road
Grand Forks, ND 58206-6002 - Phone
- (701) 780-5340
- Fax
- (701) 780-1942
- NPI assigned
- Jun 7, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 312 | ND | Primary |
| Physical Therapist | 225100000X | 2895 | MN |
Addresses
Primary practice location
1000 South Columbia Road
Grand Forks, ND 58206-6002
Mailing address
PO Box 6002
Grand Forks, ND 58206-6002
Phone (701) 780-5340
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 312 | ND | MD | Psychologist |
| 2895 | MN | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1982807020",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 6002",
"city": "GRAND FORKS",
"state": "ND",
"postal_code": "582066002",
"telephone_number": "701-780-5340",
"fax_number": "701-780-1942"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 SOUTH COLUMBIA ROAD",
"city": "GRAND FORKS",
"state": "ND",
"postal_code": "582066002",
"telephone_number": "701-780-5340",
"fax_number": "701-780-1942"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "BEVERLY",
"middle_name": "JANE",
"name_prefix": "Dr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "ND",
"license": "312",
"primary": true
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "2895",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Grand Forks, ND
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.