Provider Demographics
NPI:1184167702
Name:JOHNSON, LEVI R (DPT)
Entity type:Individual
Prefix:
First Name:LEVI
Middle Name:R
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 R AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-4602
Mailing Address - Country:US
Mailing Address - Phone:360-299-2781
Mailing Address - Fax:360-299-3038
Practice Address - Street 1:3001 R AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-4602
Practice Address - Country:US
Practice Address - Phone:360-299-2781
Practice Address - Fax:360-299-3038
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT606917632251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic