Provider Demographics
NPI:1457373847
Name:JOHNSON, DAVID M (PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
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 1:1726 EAGAN RD STE 100
Mailing Address - Street 2:UWHEALTH- PRINCETON CLUB EAST
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-3702
Mailing Address - Country:US
Mailing Address - Phone:608-265-1221
Mailing Address - Fax:
Practice Address - Street 1:1726 EAGAN RD STE 100
Practice Address - Street 2:UWHEALTH- PRINCETON CLUB EAST
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-3702
Practice Address - Country:US
Practice Address - Phone:608-265-1221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10341-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI10341-024OtherPT