Provider Demographics
NPI:1407423387
Name:JOHNSON, PAYTON WALLACE (DPT)
Entity Type:Individual
Prefix:DR
First Name:PAYTON
Middle Name:WALLACE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:386 LANDON RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-6800
Mailing Address - Country:US
Mailing Address - Phone:334-322-6510
Mailing Address - Fax:
Practice Address - Street 1:40 WISTERIA PL
Practice Address - Street 2:
Practice Address - City:MILLBROOK
Practice Address - State:AL
Practice Address - Zip Code:36054-1866
Practice Address - Country:US
Practice Address - Phone:334-285-0239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-1150225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist