Provider Demographics
NPI:1184790834
Name:JOHNSON, CRAIG ARTHUR (PT)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:ARTHUR
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 1:2633 E NANCE ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-1556
Mailing Address - Country:US
Mailing Address - Phone:480-969-9827
Mailing Address - Fax:
Practice Address - Street 1:4350 E CAMELBACK RD
Practice Address - Street 2:SUITE F-100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2701
Practice Address - Country:US
Practice Address - Phone:602-955-8700
Practice Address - Fax:602-553-8142
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1915225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1915OtherSTATE LICENSE
AZ1915OtherSTATE LICENSE