Provider Demographics
NPI:1164484077
Name:JOHNSON, LINDSAY (MPT)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
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 1:2013 ELKINS WAY
Mailing Address - Street 2:STE C
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-7380
Mailing Address - Country:US
Mailing Address - Phone:925-513-2252
Mailing Address - Fax:925-513-2253
Practice Address - Street 1:2013 ELKINS WAY STE C
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-7380
Practice Address - Country:US
Practice Address - Phone:925-513-2252
Practice Address - Fax:925-513-2253
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT30243225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT302430Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER