Provider Demographics
NPI:1619919818
Name:JOHNSON, LYNN BRANDON (PT)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:BRANDON
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 COVEY CHASE
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-1801
Mailing Address - Country:US
Mailing Address - Phone:205-345-0650
Mailing Address - Fax:
Practice Address - Street 1:3835 WATERMELON RD
Practice Address - Street 2:STE E
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-5143
Practice Address - Country:US
Practice Address - Phone:205-759-2211
Practice Address - Fax:205-759-2213
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH294225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP09410Medicare UPIN