Provider Demographics
NPI:1265838924
Name:JOHNSON, KYLE (DPT)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 SUNSET RD STE 5A
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-1126
Mailing Address - Country:US
Mailing Address - Phone:609-835-4801
Mailing Address - Fax:609-835-4950
Practice Address - Street 1:220 SUNSET RD STE 5A
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-1126
Practice Address - Country:US
Practice Address - Phone:609-835-4801
Practice Address - Fax:609-835-4950
Is Sole Proprietor?:No
Enumeration Date:2014-11-07
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT0240872251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic