Provider Demographics
NPI:1407222862
Name:JOHNSON, DANIEL (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 HIGHWAY 315
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18711-0911
Mailing Address - Country:US
Mailing Address - Phone:570-970-0402
Mailing Address - Fax:570-970-0403
Practice Address - Street 1:1140 HIGHWAY 315
Practice Address - Street 2:SUITE 207
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18711-0911
Practice Address - Country:US
Practice Address - Phone:570-970-0402
Practice Address - Fax:570-970-0403
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT024727225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist