Provider Demographics
NPI:1801003348
Name:JOHNSON, ROGER CARL (PT)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:CARL
Last Name:JOHNSON
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 1:14050 N HEMET DR
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85755-5884
Mailing Address - Country:US
Mailing Address - Phone:520-297-8465
Mailing Address - Fax:520-297-8468
Practice Address - Street 1:1313 W MAGEE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-3326
Practice Address - Country:US
Practice Address - Phone:520-797-2600
Practice Address - Fax:520-797-3100
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3867225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist