Provider Demographics
NPI:1184377194
Name:JOHNS, CHARLES RICHARD JR (PTA)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:RICHARD
Last Name:JOHNS
Suffix:JR
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 CLEAR RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:UNION BRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21791-9011
Mailing Address - Country:US
Mailing Address - Phone:443-789-8982
Mailing Address - Fax:
Practice Address - Street 1:1801 HANOVER PIKE
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:MD
Practice Address - Zip Code:21074-2128
Practice Address - Country:US
Practice Address - Phone:410-848-1329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD204416225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant