Provider Demographics
NPI:1710216320
Name:JOHNSON, KEVIN ROBB (DPT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:ROBB
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 APRICOT LN
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-3067
Mailing Address - Country:US
Mailing Address - Phone:970-639-1948
Mailing Address - Fax:970-808-2006
Practice Address - Street 1:1410 VALLEY VIEW DR STE 309
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-3130
Practice Address - Country:US
Practice Address - Phone:970-639-1948
Practice Address - Fax:970-808-2006
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10661225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist