NPI Code Detail JSON Logo

1114015997 NPI number — MARYANN S JOHNSON PT

NPI Number: 1114015997
Health Care Provider/Practitioner: MARYANN S JOHNSON PT

Information about “1114015997” NPI (MARYANN S JOHNSON PT) exists in 1114015997 in HTML format HTML  |  1114015997 in plain Text format TXT  |  1114015997 in PDF (Portable Document Format) PDF  |  1114015997 in an XML format XML  formats.

NPI Number : 1114015997 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1114015997",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JOHNSON",
    "FirstName": "MARYANN",
    "MiddleName": "S",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SMITH",
    "OtherFirstName": "MARYANN",
    "OtherMiddleName": "J",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "PT",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "3500 AMERICAN BLVD W STE 300",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BLOOMINGTON",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "55431-4442",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "952-512-5600",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4040 RADIO DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WOODBURY",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "55129-3237",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "651-439-8807",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/10/2006",
    "LastUpdateDate": "12/24/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "225100000X",
        "TaxonomyName": "Physical Therapist",
        "LicenseNumber": "2886",
        "LicenseNumberStateCode": "MN",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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