Provider Demographics
NPI:1356629943
Name:JOHNSON, HENRY AARON (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:AARON
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:MR
Other - First Name:HENRY
Other - Middle Name:AARON
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:PO BOX 324
Mailing Address - Street 2:
Mailing Address - City:FORT MORGAN
Mailing Address - State:CO
Mailing Address - Zip Code:80701-0324
Mailing Address - Country:US
Mailing Address - Phone:208-431-6931
Mailing Address - Fax:
Practice Address - Street 1:716 COLFAX ST
Practice Address - Street 2:
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-4084
Practice Address - Country:US
Practice Address - Phone:208-431-6931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1152225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist