Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mr. Wayne Michael Johnson, PTA, CCI

Individual provider Physical Therapy Assistant · NPI 1720096241

Mr. Wayne Michael Johnson, PTA, CCI is a Physical Therapy Assistant in Fort Drum, New York. Licensed in New York. Registered with an NPI since 2006.

Licensed in
NY
In the registry since
2006
What do these letters mean?
PTA — Physical Therapist Assistant
Delivers treatment under a physical therapist's direction.

See every abbreviation used in this directory →

Practice location Address checks out

11050 Mt Belvedere Blvd USA Meddac /credentials
Fort Drum, NY 13602-5004
Phone: (315) 772-4025
Fax: (315) 772-9498
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapy Assistant (primary) Taxonomy 225200000X · Licence 004281 (NY)

Record details

NPI number1720096241
Entity typeIndividual (Type 1)
GenderMale
Credentials PTA , CCI
Sole proprietorNo
NPI enumeratedAugust 3, 2006
Last updated in NPPESJuly 8, 2007
Mailing address11050 Mt Belvedere Blvd, Usa Meddac / Credentials, Fort Drum, NY 13602-5004

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