Provider Demographics
NPI:1003961137
Name:JOHNSON, STEVEN W (DPT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:W
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:E7596 GREENWING LN
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:WI
Mailing Address - Zip Code:54940-8854
Mailing Address - Country:US
Mailing Address - Phone:920-446-2792
Mailing Address - Fax:
Practice Address - Street 1:106 S HOLMEN DR
Practice Address - Street 2:SUITE 2
Practice Address - City:HOLMEN
Practice Address - State:WI
Practice Address - Zip Code:54636-9467
Practice Address - Country:US
Practice Address - Phone:608-526-9888
Practice Address - Fax:608-526-9965
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9694-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI9694-024OtherPHYSICAL THERAPY LICENSE