Provider Demographics
NPI:1346440872
Name:JOHNSON, RON BURTON (MPT)
Entity Type:Individual
Prefix:MR
First Name:RON
Middle Name:BURTON
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:27125 SIERRA HWY STE 203
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-5429
Mailing Address - Country:US
Mailing Address - Phone:661-250-9940
Mailing Address - Fax:661-250-9959
Practice Address - Street 1:805 W PALMDALE BLVD
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-4251
Practice Address - Country:US
Practice Address - Phone:661-947-9977
Practice Address - Fax:661-947-9988
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29952225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist