Provider Demographics
NPI:1255995312
Name:JOHNSON, DAVID PAUL (MSPT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:PAUL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 SHINY MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SPRING BROOK TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18444-6439
Mailing Address - Country:US
Mailing Address - Phone:570-451-3282
Mailing Address - Fax:
Practice Address - Street 1:500 W HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:PA
Practice Address - Zip Code:18517-2012
Practice Address - Country:US
Practice Address - Phone:570-562-2102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013576L2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics