Provider Demographics
NPI:1043295298
Name:JOHNSON, NORMAN L (PT DPT)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 GREENSBURG AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MC KEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15035-1417
Mailing Address - Country:US
Mailing Address - Phone:412-816-1001
Mailing Address - Fax:
Practice Address - Street 1:445 GREENSBURG AVE
Practice Address - Street 2:
Practice Address - City:EAST MC KEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15035-1417
Practice Address - Country:US
Practice Address - Phone:412-816-1001
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005418L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA512392Medicare ID - Type Unspecified