Provider Demographics
NPI:1407817315
Name:JOHNS, BRUCE CARLETON (PT)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:CARLETON
Last Name:JOHNS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 LINDEN DR
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:PA
Mailing Address - Zip Code:19526-8924
Mailing Address - Country:US
Mailing Address - Phone:610-562-0970
Mailing Address - Fax:
Practice Address - Street 1:400 PINE BROOK PL
Practice Address - Street 2:SUITE 2
Practice Address - City:ORWIGSBURG
Practice Address - State:PA
Practice Address - Zip Code:17961-2350
Practice Address - Country:US
Practice Address - Phone:570-366-0300
Practice Address - Fax:570-366-3999
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT002285E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1708772/01Medicaid
PA764150OtherBLUESHIELD
PA03066900OtherCAPITAL BLUE CROSS
PA0017087720002Medicaid
PA1708772/01Medicaid