Provider Demographics
NPI:1801097779
Name:JOHNSON, HOWARD FINLAYSON
Entity type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:FINLAYSON
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 BENJAMIN WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:OR
Mailing Address - Zip Code:97535-7714
Mailing Address - Country:US
Mailing Address - Phone:541-512-8770
Mailing Address - Fax:
Practice Address - Street 1:1710 NE FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-3877
Practice Address - Country:US
Practice Address - Phone:541-479-2602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2457225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist