Provider Demographics
NPI:1508844069
Name:JOHNSON, RICHARD J (PT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:RICK
Other - Middle Name:J
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:1490 E FOREMASTER DR STE 110
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790
Mailing Address - Country:US
Mailing Address - Phone:435-652-4455
Mailing Address - Fax:435-652-4472
Practice Address - Street 1:1490 E FOREMASTER DR
Practice Address - Street 2:STE 110
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790
Practice Address - Country:US
Practice Address - Phone:435-652-4455
Practice Address - Fax:435-652-4472
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5071225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
107008400102OtherIHC
0M0000055827OtherALTIUS
311308OtherDMBA
87726OtherUHC
61582OtherPEHP
UT4706030002Medicare NSC
107008400102OtherIHC