Provider Demographics
NPI:1740447341
Name:JOHNSON, TAYLOR CLINTON JR (MPT)
Entity type:Individual
Prefix:MR
First Name:TAYLOR
Middle Name:CLINTON
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6701 LAKE WOODLANDS DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382
Mailing Address - Country:US
Mailing Address - Phone:281-419-3100
Mailing Address - Fax:281-419-3101
Practice Address - Street 1:6701 LAKE WOODLANDS DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382
Practice Address - Country:US
Practice Address - Phone:281-419-3100
Practice Address - Fax:281-419-3101
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1115871225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG44199Medicare UPIN