Provider Demographics
NPI:1801852405
Name:JOHNSON, PHILIP (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2336 DRAPER AVE
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-4312
Mailing Address - Country:US
Mailing Address - Phone:734-528-9168
Mailing Address - Fax:
Practice Address - Street 1:2336 DRAPER AVE
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-4312
Practice Address - Country:US
Practice Address - Phone:734-528-9168
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer