Provider Demographics
NPI:1093080228
Name:JOHNSON, GREGORY PAUL (PT, DPT)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:PAUL
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 1:986 QUAIL RDG
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-2925
Mailing Address - Country:US
Mailing Address - Phone:903-818-7696
Mailing Address - Fax:
Practice Address - Street 1:986 QUAIL RDG
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-2925
Practice Address - Country:US
Practice Address - Phone:903-818-7696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1187290225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist