Provider Demographics
NPI:1467731778
Name:JOHNSON, THOMAS HENRY (RES)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:HENRY
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:RES
Other - Prefix:
Other - First Name:TORRENCE
Other - Middle Name:HENRY
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RES
Mailing Address - Street 1:345 E AVENUE J7
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-3644
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:345 E AVENUE J7
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-3644
Practice Address - Country:US
Practice Address - Phone:661-942-9770
Practice Address - Fax:661-942-9770
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist