Provider Demographics
NPI:1558993022
Name:JOHNSON, CHRISTOPHER BRIAN (LPTA)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:BRIAN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2027 CAPLES RD
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71292-8474
Mailing Address - Country:US
Mailing Address - Phone:720-989-3730
Mailing Address - Fax:
Practice Address - Street 1:2027 CAPLES RD
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71292-8474
Practice Address - Country:US
Practice Address - Phone:720-989-3730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-12
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA.0014430225200000X
LAA10979R225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant