Provider Demographics
NPI:1407084817
Name:JOHNSON, MATTHEW TODD (DPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:TODD
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 1:2301 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-9540
Mailing Address - Country:US
Mailing Address - Phone:484-851-3386
Mailing Address - Fax:484-851-3469
Practice Address - Street 1:1174 ILLICKS MILL RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-3652
Practice Address - Country:US
Practice Address - Phone:610-419-9755
Practice Address - Fax:610-419-8532
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT019980225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist