Provider Demographics
NPI:1083735328
Name:JOHNS, KEVIN (PT, ATC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:JOHNS
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2918 SWAN DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-1423
Mailing Address - Country:US
Mailing Address - Phone:903-295-9818
Mailing Address - Fax:
Practice Address - Street 1:103 W LOOP 281
Practice Address - Street 2:SUITE 800
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-4653
Practice Address - Country:US
Practice Address - Phone:903-315-5580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1065290225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist