Provider Demographics
NPI:1760795843
Name:JOHNSON, BRANDY MICHELLE (DPT)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:MICHELLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 S DOUGLAS HWY STE 120
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-4949
Mailing Address - Country:US
Mailing Address - Phone:307-670-8111
Mailing Address - Fax:307-670-8113
Practice Address - Street 1:1211 S DOUGLAS HWY STE 120
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-4949
Practice Address - Country:US
Practice Address - Phone:307-358-9464
Practice Address - Fax:307-358-9330
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-1332225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist