Provider Demographics
NPI:1205591419
Name:JOHNSON FAMILY PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:JOHNSON FAMILY PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPT / CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDE
Authorized Official - Middle Name:T
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:307-578-8123
Mailing Address - Street 1:538 YELLOWSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-9300
Mailing Address - Country:US
Mailing Address - Phone:307-578-8123
Mailing Address - Fax:307-578-8121
Practice Address - Street 1:538 YELLOWSTONE AVE
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-9300
Practice Address - Country:US
Practice Address - Phone:307-578-8123
Practice Address - Fax:307-578-8121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-02
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy