Provider Demographics
NPI:1023904513
Name:JOHNSON, ADAM MICHAEL (PTA)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:MICHAEL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:MR
Other - First Name:ADAM
Other - Middle Name:MICHAEL
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:5701 KIAM ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-1141
Mailing Address - Country:US
Mailing Address - Phone:225-218-3421
Mailing Address - Fax:
Practice Address - Street 1:5701 KIAM ST UNIT B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-1141
Practice Address - Country:US
Practice Address - Phone:225-218-3421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA13552922081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine