Provider Demographics
NPI:1154482008
Name:JOHNSON, DAVID ANDREW (PT)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ANDREW
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 1:1770 1ST ST STE 100
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3210
Mailing Address - Country:US
Mailing Address - Phone:847-432-4077
Mailing Address - Fax:847-681-8940
Practice Address - Street 1:1770 1ST ST STE 100
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3210
Practice Address - Country:US
Practice Address - Phone:847-432-4077
Practice Address - Fax:847-681-8940
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.017873225100000X, 225100000X
IL070017873208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL73851OtherPIN
ILL73851OtherPIN