Provider Demographics
NPI:1528021607
Name:JOHNSON, RUSSELL C (PT)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:C
Last Name:JOHNSON
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 1:7750 DANNAHER DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-4039
Mailing Address - Country:US
Mailing Address - Phone:865-512-1140
Mailing Address - Fax:655-121-1418
Practice Address - Street 1:7750 DANNAHER DR
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-4039
Practice Address - Country:US
Practice Address - Phone:865-512-1140
Practice Address - Fax:865-512-1141
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT014283225100000X
TN7226225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
9985704OtherAETNA
TN8660463OtherCIGNA
TN4110845OtherBLUE CROSS BLUE SHIELD
TN8660463OtherCIGNA
9985704OtherAETNA