Provider Demographics
NPI:1821040437
Name:JOHNSON, DAVID A (PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
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 1:2874 N CARSON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-0177
Mailing Address - Country:US
Mailing Address - Phone:775-883-4161
Mailing Address - Fax:
Practice Address - Street 1:1701 COUNTY RD
Practice Address - Street 2:#B
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-4464
Practice Address - Country:US
Practice Address - Phone:775-782-4466
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1567225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV35596Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER