Provider Demographics
NPI:1578523544
Name:JOHNS, WAYNE LESTER (PT)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:LESTER
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 1:1550 W LEESPORT RD
Mailing Address - Street 2:
Mailing Address - City:LEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:19533-9311
Mailing Address - Country:US
Mailing Address - Phone:610-926-2634
Mailing Address - Fax:
Practice Address - Street 1:800 SHOEMAKER AVE
Practice Address - Street 2:
Practice Address - City:SHOEMAKERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19555-1635
Practice Address - Country:US
Practice Address - Phone:610-562-0437
Practice Address - Fax:610-562-0522
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT000260-E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist