Provider Demographics
NPI:1780793836
Name:JOHNSON, JAMES TOBY (RKT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:TOBY
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:RKT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5514 LEGACY OAKS DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-7927
Mailing Address - Country:US
Mailing Address - Phone:254-760-1472
Mailing Address - Fax:
Practice Address - Street 1:1901 VETERANS MEMORIAL DRIVE
Practice Address - Street 2:OLIN E TEAGUE MEDICAL CENTER
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504
Practice Address - Country:US
Practice Address - Phone:254-743-1931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1423225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner