Provider Demographics
NPI:1144226283
Name:JOHNSON, NAJIB CHAPMAN (PT)
Entity Type:Individual
Prefix:MR
First Name:NAJIB
Middle Name:CHAPMAN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1280 N MILDRED RD
Mailing Address - Street 2:STE 2
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-2212
Mailing Address - Country:US
Mailing Address - Phone:970-564-0311
Mailing Address - Fax:970-564-0313
Practice Address - Street 1:1280 N MILDRED RD
Practice Address - Street 2:STE 2
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-2212
Practice Address - Country:US
Practice Address - Phone:970-564-0311
Practice Address - Fax:970-564-0313
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4149225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO96583321Medicaid
CO96583321Medicaid