Provider Demographics
NPI:1083989941
Name:JOHNSON, PATTI B (MPT)
Entity Type:Individual
Prefix:
First Name:PATTI
Middle Name:B
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:742 S HIGHWAY 66
Mailing Address - Street 2:
Mailing Address - City:MORGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84050-9555
Mailing Address - Country:US
Mailing Address - Phone:661-537-3663
Mailing Address - Fax:
Practice Address - Street 1:742 S HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:MORGAN
Practice Address - State:UT
Practice Address - Zip Code:84050-9555
Practice Address - Country:US
Practice Address - Phone:661-537-3663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-12
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT119811-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist