Provider Demographics
NPI:1326034620
Name:JOHNSON, JOSEPH L (CP, CTPO)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:CP, CTPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 E GARDEN DR
Mailing Address - Street 2:STE H
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-3148
Mailing Address - Country:US
Mailing Address - Phone:970-686-2266
Mailing Address - Fax:970-686-8823
Practice Address - Street 1:561 E GARDEN DR
Practice Address - Street 2:STE H
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-3148
Practice Address - Country:US
Practice Address - Phone:970-686-2266
Practice Address - Fax:970-686-8823
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO15753224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY117954300Medicaid
CO97021032Medicaid
CO97021032Medicaid
WY4097670002Medicare PIN