Provider Demographics
NPI:1790781516
Name:JOHNSON, BRADLEY N (PHYSCIAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:N
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHYSCIAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3838 OLD PLAIN DEALING RD
Mailing Address - Street 2:
Mailing Address - City:PLAIN DEALING
Mailing Address - State:LA
Mailing Address - Zip Code:71064-3424
Mailing Address - Country:US
Mailing Address - Phone:318-326-5102
Mailing Address - Fax:318-326-7120
Practice Address - Street 1:309 S LOUISIANA ST
Practice Address - Street 2:
Practice Address - City:PLAIN DEALING
Practice Address - State:LA
Practice Address - Zip Code:71064-3431
Practice Address - Country:US
Practice Address - Phone:318-326-7120
Practice Address - Fax:318-326-7120
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04136225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist