Provider Demographics
NPI:1114981784
Name:JOHNSON, MICHAEL ROBERT (DSCPT, OCS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROBERT
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DSCPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:578A BENEDICT RD
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10996-1205
Mailing Address - Country:US
Mailing Address - Phone:845-938-3067
Mailing Address - Fax:845-938-8114
Practice Address - Street 1:KELLER ARMY COMMUNITY HOSPITAL, ARVIN GYMNASIUM
Practice Address - Street 2:900 WASHINGTON ROAD
Practice Address - City:WEST POINT
Practice Address - State:NY
Practice Address - Zip Code:10996
Practice Address - Country:US
Practice Address - Phone:845-938-3324
Practice Address - Fax:845-938-8114
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27992251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic